(B-031) Changes in Outpatient Care Utilization Among Medicare Beneficiaries with Atrial Fibrillation Following the Covid-19 Pandemic

Background: The COVID-19 pandemic disrupted healthcare delivery for chronic diseases, leading to a decline in in-person visits and a rapid increase in telehealth utilization. However, little is known about whether patients with atrial fibrillation (AF) have returned to pre-pandemic levels of healthcare utilization and how changes in healthcare utilization varied across patient subgroups based on baseline healthcare needs.

Objectives: To evaluate trends in telehealth and in-person visits before and after the COVID-19 pandemic in patients with AF and to examine differences in changes in healthcare utilization across patient groups with varying baseline care needs.

Methods: Using 2018-2022 data, we identified continuously enrolled Medicare beneficiaries with established AF before March 2019. We assessed the average number of 90-day in-person, telehealth, and total outpatient visits across three periods: the baseline period (March 2019–March 2020), the pandemic period (March 2020–December 2021), and the post-pandemic period (December 2021–December 2022). Patients were categorized into quartiles based on the mean number of in-person visits per quarter of the baseline period, with Groups 1 to 4 representing the lowest to highest average visits.

Results: The final cohort included 124,483 patients with established AF with mean age 78.5  9.0 years, 54.0% were female and 90.0% non-Hispanic White. We identified four subgroups based on the number of in-person outpatient visits during the baseline period, with mean visit rates of 0.4, 1.8, 3.0, and 5.8 per 90 days for Group 1 to 4. During the pandemic, there was a decline in in-person visits and an increase in telehealth visits across all groups. In the post-pandemic period, total visits increased for Groups 1 and 2 ( 0.42 to 0.84 visits and 1.76 to 2.02 visits, respectively), driven by increases in both telehealth and in-person visits. However, outpatient visits remained lower than pre-pandemic levels for Groups 3 and 4. In Group 4, total visits declined by 1.7 visits (95% CI: 1.4–1.9), with a modest increase of 0.2 telehealth visits, while in-person visits dropped from 5.8 to 4.1 per 90 days.

Conclusions: Telehealth use and the gradual recovery of in-person visits in the post-pandemic period contributed to the restoration of outpatient care levels across the population of patients with AF. However, there were differences across subgroups: while patients with lower baseline care needs experienced increased total visits post-pandemic, those with higher baseline care needs faced reduced outpatient visits compared to the pre-pandemic levels.