Abstract 4362685: Utilizing Telemedicine to Promote Equitable Care for Higher Risk Orthotopic Heart Transplant Recipients: A Single Center Analysis

Abstract

Introduction: Orthotopic heart transplantation (OHT) is the definitive treatment in patients with advanced heart failure. The medical and psychosocial complexity of OHT requires multidisciplinary care. Several tools, including the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), have been developed to objectively guide a psychosocial evaluation prior to OHT. We previously found that patients in the high-risk SIPAT categories were more likely to live in a county with greater income inequality and had significantly reduced long-term survival. Research Question: We examined whether there was a difference in healthcare utilization in a cohort of OHT recipients with high-risk versus low-risk SIPAT scores two years post-OHT. Methods: Examiners obtained patient data from a single center, retrospective cohort of 144 OHT recipients between June 2019 and January 2024. For blinding, a separate group of examiners performed SIPAT scoring. Recipients with “Excellent” or “Good” score (E/G) were compared with patients who had higher-risk scores, including “Minimum Acceptable Criteria,” “High Risk,” or “Poor” (MAC/HR/P). Chi-square and t-tests were used to study associations between SIPAT score and outcomes. Results: We found a significant difference in the average lifespan of OHT recipients between E/G and MAC/HR/P (45.7 vs 51.7 months, p=0.04). MAC/HR/P patients had an average of 50 telemedicine encounters compared to 45 (p=0.11) in the E/G group in the first year post-OHT. In the second year, there was an average of 27 telemedicine encounters versus 22 (p=0.05), respectively. There was no difference in the number of clinic visits between the MAC/HR/P group and E/G group in the first (21 vs. 19, p=0.11) or second years (6.5 vs 5.8, p=0.39) post-OHT. There was also no difference in the number of hospitalizations between the MAC/HR/P and E/G groups in the first (0.70 vs 0.64, p=0.82) or second years (0.87 vs 0.69, p=0.6) post-OHT. Conclusion: In comparison to our prior findings, this cohort showed an increase in lifespan in OHT recipients in the high-risk group. Notably, there was more telemedicine utilization in the high-risk group after the first year post-OHT. Our findings suggest that telemedicine interventions by an interdisciplinary team may contribute to decreased mortality in higher risk OHT recipients. Moreover, this could represent a low-cost, scalable, and equitable approach to improving outcomes in OHT patients with psychosocial risk factors.