Patel, Parth

ImportanceThere was a shift in patient volume from in-person to video telemedicine visits during the COVID-19 pandemic.ObjectiveTo determine the concordance of provisional diagnoses established at a video telemedicine visit with diagnoses established at an in-person visit for patients presenting with a new clinical problem.Design, Setting, and ParticipantsThis is a diagnostic study of patients who underwent a video telemedicine consultation followed by an in-person outpatient visit for the same clinical problem in the same specialty within a 90-day window. The provisional diagnosis made during the video telemedicine visit was compared with the reference standard diagnosis by 2 blinded, independent medical reviewers. A multivariate logistic regression model was used to determine factors significantly related to diagnostic concordance. The study was conducted at a large academic integrated multispecialty health care institution (Mayo Clinic locations in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; and Jacksonville, Florida; and Mayo Clinic Health System locations in Iowa, Wisconsin, and Minnesota) between March 24 and June 24, 2020. Participants included Mayo Clinic patients residing in the US without age restriction. Data analysis was performed from December 2020 to June 2021.ExposuresNew clinical problem assessed via video telemedicine visit to home using Zoom Care Anyplace integrated into Epic.Main Outcomes and MeasuresConcordance of provisional diagnoses established over video telemedicine visits compared against a reference standard diagnosis.ResultsThere were 2393 participants in the analysis. The median (IQR) age of patients was 53 (37-64) years; 1381 (57.7%) identified as female, and 1012 (42.3%) identified as male. Overall, the provisional diagnosis established over video telemedicine visit was concordant with the in-person reference standard diagnosis in 2080 of 2393 cases (86.9%; 95% CI, 85.6%-88.3%). Diagnostic concordance by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision chapter ranged from 64.7% (95% CI, 42.0%-87.4%) for diseases of the ear and mastoid process to 96.8% (95% CI, 94.7%-98.8%) for neoplasms. Diagnostic concordance by medical specialty ranged from 77.3% (95% CI, 64.9%-89.7%) for otorhinolaryngology to 96.0% (92.1%-99.8%) for psychiatry. Specialty care was found to be significantly more likely than primary care to result in video telemedicine diagnoses concordant with a subsequent in-person visit (odds ratio, 1.69; 95% CI, 1.24-2.30; P < .001).Conclusions and RelevanceThis diagnostic study of video telemedicine visits yielded a high degree of diagnostic concordance compared with in-person visits for most new clinical concerns. Some specific clinical circumstances over video telemedicine were associated with a lower diagnostic concordance, and these patients may benefit from timely in-person follow-up.

Background: Transcatheter aortic valve replacement (TAVR) is an approved alternative to surgical aortic valve replacement. However, as the clinical indication and adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to study the impact of aortic valve calcium score on long term mortality following TAVR in a large patient population. Methods: We included consecutive patients who successfully underwent TAVR from June 2010 – June 2019 across all Mayo Clinic sites. Patients were followed through February 2021. Aortic valve calcium scores were obtained from preoperative computed tomography angiography of the chest. Additional data was abstracted from medical records. Cox-proportional hazard regression models were employed to evaluate the independent effect of aortic valve calcium score on mortality. Results: A total of 1988 patients were evaluated in the final analysis. Forty-two percent were women, median age was 83 years (Q1: 77, Q3: 87), 16% received a permanent pacemaker following TAVR and 83% received an Edwards Sapien valve. We demonstrate an incremental increase in mortality risk as aortic valve calcium score values increased after adjusting for age, gender, pacemaker implantation, left bundle branch block, and Charlson Comorbidity Index. Selected calcium score cut-points with adjusted hazard ratios (aHR) are displayed: 1200 AU (aHR: 1.13, 95% CI 1.06, 1.20); 2000 AU (aHR: 1.22, 95% CI 1.09, 1.35); 3000 AU (aHR: 1.34, 95% CI: 1.14, 1.58). Conclusion: This study demonstrates an association between aortic valve calcium score and long-term mortality in a large patient population. This highlights the potential predictive value of the calcium score in preoperative planning and may provide clinicians with an additional measure for risk stratification prior to TAVR.