{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T20:12:02Z","timestamp":1788207122800,"version":"build-2803163510"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["HSRD funding IRP 20-003"],"award-info":[{"award-number":["HSRD funding IRP 20-003"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec025\">\n<jats:title>Background<\/jats:title>\n<jats:p>The mortality risk associated with loss of in-person outpatient visits or transition to virtual care in patients with heart failure (HF) during the COVID-19 pandemic is unknown.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec026\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Assess changes in outpatient HF care patterns and associated mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec027\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Retrospective analysis of HF patients using national Veterans-Health-Administration (VHA) data. Among 509,511 HF patients who received VHA care, we compared mean monthly days-with-an-outpatient-visit from 2\/2018\u20131\/2020 (pre-COVID) versus 2\/2020\u20131\/2021 (COVID) using T-tests. In a subset of 321,439 patients with \u22651 VHA cardiology or primary-care visit in 2019, we related the presence and type of outpatient visit with mortality using Cox-Regression estimated hazard-ratios (HRs).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec028\">\n<jats:title>Results<\/jats:title>\n<jats:p>Despite a 2\u20133-fold increase in video-only visits and use of telephone visits to maintain access, the overall days with outpatient visits decreased from a monthly-average of 81.4\u2009\u00b1\u20096.1 in 2018\u20132019 and 81.0\u2009\u00b1\u20095.6 in 2019\u20132020, to 57.8\u2009\u00b1\u200911 days in 2020\u20132021 (P\u2009&lt;\u20090.01 for both), per 100 Veterans. When compared to patients with no-visits during the study period, the adjusted-mortality risk was lowest for patients with at least one in-person (HR 0.42, 95%CI: 0.41\u20130.44), followed by video-only (HR 0.52, 95%CI: 0.50\u20130.55) and then telephone-only (HR 0.57, 95%CI: 0.54\u20130.60) visits (p\u2009=\u20090.14 for trend). Results remained similar when the analysis was repeated (without including telephone visits) for pre-COVID (2\/2018\u20131\/2020) periods.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec029\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Despite an increase in video and use of telephone visits during the COVID-19 pandemic, there was still a decrease in total outpatient visits for patients with HF. The presence and type of outpatient encounter was associated with the adjusted risk of mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323308","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T17:26:33Z","timestamp":1747416393000},"page":"e0323308","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outpatient care changes and associated mortality among Veterans with heart failure during the COVID-19 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