As chief medical officer at Heartbeat Health, a virtual-first cardiology practice, Dr. Jana Goldberg is at the intersection of telehealth and cardiology care.
She has several concerns when it comes to telemedicine and cardiac care. She’s worried about access, because the supply-demand mismatch in cardiology is critical. She wants to improve outcomes, because she believes virtual care enables rapid titration of guideline-directed therapy. She’s focused on resource optimization, because cardiologists can stratify patients by need with telemedicine. And she’s interested in the role of hybrid models because virtual care will never replace in-person procedures or acute interventions.
We spoke with Goldberg so she could elaborate on those concerns, and discuss her years of experience and deep expertise in the field.
Q. 46% of U.S. counties lack a local cardiologist and urban wait times exceed 30 days. How can telecardiology help overcome these access challenges?
A. That’s right. Almost half of the U.S. counties, impacting 22 million residents, have no cardiologist located in their area. These tend to be areas that are rural and socioeconomically disadvantaged.
Patients living in those areas already have a high risk of heart disease due to underlying risk factors and, astoundingly, a one-year shorter life expectancy than those with cardiologists. The problem extends into urban settings where some appointment times exceed 30 days depending on the city and continue to go up.
Further, a quarter of cardiologists intend to leave over the coming years. With a population getting sicker, we are facing a critical supply/demand mismatch.
Given both the current and projected outlook, telecardiology will serve an essential function in the coming decades. Here, I define telecardiology more broadly than just connecting cardiologists and patients via tele-visits. Rather, it is the larger implementation of remote-first diagnosis and treatment for patients with cardiovascular conditions.
Traditional models requiring a stepwise approach to work up and management typically start with a referral to a face-to-face cardiologist. Given capacity constraints despite need, the specialty model will have to evolve to support more innovative pathways that one can introduce diagnostics into non-traditional settings – the home, primary care – as well as support for the output of those results by connecting patients with specialists outside of their existing geography.
Q. How can telecardiology reduce hospitalizations and mortality rates?
A. There have been numerous clinical trials challenging the impact of telecardiology on various endpoints of interest, including blood pressure and cholesterol control, hospitalization, mortality, quality of life, among others.
Though some of the trials have had mixed data, they have also employed different models to effectuate impact. Overall, the literature supports that it can play a significant impact in improving outcomes.
A recent meta-analysis synthesizing evidence from 29 randomized trials and involving nearly 14,000 adults with heart failure illustrated that telecardiology significantly reduced hospitalization by 6% and mortality by 10%. Leveraging telecardiology not only reduces readmission, it improves health literacy and quality of life.
Though there are several reasons as to why we’re seeing these outcomes, including closer monitoring and patient oversight, one of the major drivers is likely getting patients on aggressive medical therapy that has proven reduction in hospitalization and risk of death.
This is particularly true for the heart failure population that drives our highest costs. For every three patients with a reduced heart function we can get on appropriate therapy, we keep one out of the hospital. Compared to other things we can do in medicine, that number is incredibly powerful.
Telecardiology simply connects the dots to get patients on the right treatment, at the right speed, at the right time.
Q. What can telecardiology do to reduce unnecessary visits while ensuring high-quality care?
A. I would break down the impact into a couple different areas: routine like ambulatory care visits and high acuity like ER visits.
Given the breadth of disease, we need better ways to manage the influx of patients into the specialty outpatient, or ambulatory care setting. The right way to think about using telecardiology in this setting is using innovative care pathways to meet the level of patient need.
In this setting, we need to lean into a primary care-first model but maintain adequate support from specialists. For many questions, an e-consult pathway can provide primary care physicians with what is needed to manage a patient themselves.
In this case, you see diversion of specialty outpatient slot utilization away from lower acuity patients and avoidance of unnecessary E/M visits. Further, we can spare face-to-face visits for medication titration, also improving the speed to which we get patients on the right regimens quickly (and improving outcomes).
With regard to high-acuity care, it is estimated up to two-thirds of ER visits are avoidable, or an estimated $32 billion in healthcare costs annually. Many of these issues may be solved on an outpatient basis; however, the current primary care model needs to evolve in order to offload these costs.
When we leverage telecardiology to support primary care physicians in a collaborative care model, we elevate their capabilities beyond what both infrastructure and capacity allows.
In summary, telecardiology allows for the carve out of innovative pathways that can avoid our traditional brick-and-mortar workflows, alleviating on-the-ground teams and unnecessary spending.
Q. The hybrid model in telemedicine seems to be the wave of the future. What happens when you blend telecardiology and brick-and-mortar care?
A. I see this hybridization occur in three key areas: primary care, home care and other specialty practices. As we speak, these models are rolling out sequentially.
For several years, in primary care practices – particularly at-risk organizations or ACOs – telecardiology became a natural adjunct to their broader cardiovascular strategy. The objective has been clear: control healthcare costs while delivering high-quality care. In a fragmented healthcare landscape that varies dramatically by market, telecardiology has helped bridge geographic divides and unify specialty strategies – an organic and necessary evolution.
Next, healthcare is increasingly shifting into the home. Meeting patients where they are is essential, especially for those who face barriers to traditional in-person care. With clinicians delivering diagnoses and management in-home, this approach supports both routine and high-risk care. As this trend accelerates, telemedicine will play a critical role in supporting on-the-ground teams.
Finally, specialists are progressively turning to virtual partners to enhance their care delivery. This shift is happening in three key ways: managing post-hospitalization patients amid capacity constraints, streamlining and specializing new patient intake, and strengthening referral pathways through demonstrated quality and reliability.
These interconnected pathways signal a broader transformation in care delivery. I’m excited to see them evolve because, ultimately, they are necessary – and most important, they are what’s best for patients.
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Email him: bsiwicki@himss.org
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