Effect of Telehealth Services on Mitral and Tricuspid Regurgitation Progression: Retrospective Study (Preprint)

Abstract

BACKGROUND Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with poor outcomes and high mortality risks which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, has been proven to improve health management of chronic diseases, but its effects on MR and TR progression are unknown. OBJECTIVE We aimed to explore whether patients with telehealth services have less MR and TR progression compared with a control group. We also aimed to identify predictors of MR and TR progression. METHODS This single-center retrospective study conducted at National Taiwan University Hospital in Taiwan compared MR and TR progression (defined as either progression to ≥ moderate MR/TR or MR/TR progression by ≥ 2 grades during the study period) between the telehealth and control groups. All patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR/TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who had received telehealth service for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson comorbidity index (CCI) score components were obtained for all patients. RESULTS A total of 1,081 patients (226 in the telehealth group and 855 in the control group) were included in study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (p<0.001), higher CCI (p=0.015), higher prevalence of prior myocardial infarction (p=0.01) and heart failure (p <0.001), higher beta blocker(p=0.028) and diuretic (p=0.041) use, and lower nitrate use (p=0.044). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio [HR], 1.10; 95% confidence interval [CI] 0.80-1.52; p=0.52) and TR (HR, 1.27; 95% CI 0.92-1.74; p=0.14) progression. Predictors for MR progression ≥ moderate included older age, female sex, diuretic use, larger left atrial (LA) dimension, left ventricular end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD), and lower LV ejection fraction (LVEF). Predictors of TR progression ≥moderate included older age, female sex, diuretic use, presence of atrial fibrillation (AFib), LA dimension, LVESD, and lower LVEF; statin use was protective. CONCLUSIONS This is the first study to assess the association between telehealth and progression of MR or TR. Telehealth patients, who had more comorbidity, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and AFib, which can be incorporated into a telehealth platform and advanced alert system to improve patient outcomes through personalized care.