Among patients with cardiovascular disease receiving follow-up, a considerable proportion (27.3% to 51.7% depending on condition) received partially virtual care, with use increasing during COVID-19 and remaining high afterward, and small absolute differences found in the initiation of new guideline-directed medical therapy between virtual and in-person visits.
Key Findings
Results
A substantial proportion of cardiovascular patients received partially virtual follow-up care, varying by condition.
27.3% of AF patients (12,517/45,919) had partially virtual follow-up
51.7% of HF patients (15,749/30,482) had partially virtual follow-up
47.5% of PE patients (5,918/12,451) had partially virtual follow-up
37.2% of ACS patients (4,627/12,435) had partially virtual follow-up
Study used nationwide Danish registries covering patients with first-time diagnoses between 2019 and 2023
Results
Use of partially virtual follow-up increased during the COVID-19 pandemic and remained elevated afterward.
In 2023, 17.4% (475/2,731) to 35.3% (876/2,481) of patients' first follow-up visits were virtual, depending on the condition
The temporal trend showed a rise during the pandemic period with sustained high utilization post-pandemic
The study period spanned 2019–2023, capturing both pre-pandemic, pandemic, and post-pandemic periods
Results
Urban residence was significantly associated with higher odds of receiving partially virtual care for most conditions.
AF patients residing in cities had OR 1.27 (95% CI 1.21–1.34) for partially virtual care
HF patients residing in cities had OR 1.38 (95% CI 1.31–1.46) for partially virtual care
PE patients residing in cities had OR 1.14 (95% CI 1.04–1.24) for partially virtual care
Urban residence was not significantly associated with partially virtual care for ACS patients
Models were adjusted for frailty score, residence, and period of diagnosis
Results
High frailty was associated with significantly higher odds of receiving partially virtual care for AF and PE patients.
AF patients with high frailty had OR 1.63 (95% CI 1.48–1.80) for partially virtual care
PE patients with high frailty had OR 1.53 (95% CI 1.29–1.81) for partially virtual care
Frailty score was included as an adjustment variable in multivariable logistic regression models
Results
Differences in new initiation of guideline-directed medical therapy (GDMT) between virtual and in-person visits were small in absolute terms across all conditions.
For HF patients, 2.23% initiated SGLT-2 inhibitors following a virtual visit vs. 4.47% after an in-person visit (prevalence difference -2.24%, 95% CI -2.61 to -1.87)
A large percentage of patients were already on GDMT prior to their first follow-up visit, limiting the pool eligible for new initiation
Analysis used separate multivariable logistic regression models adjusted for frailty score, residence, and period of diagnosis
The exposure for GDMT analysis was the type of the patient's first follow-up visit (virtual vs. in-person)
Results
Patient-specific factors significantly influenced the odds of receiving partially virtual versus in-person cardiovascular care.
Place of residence and frailty score were identified as significant patient-level determinants of care modality
Multivariable logistic regression was adjusted for frailty score, residence, and period of diagnosis
The association between frailty and virtual care was condition-specific, being significant for AF and PE but not consistently across all four conditions
What This Means
This research examined how often patients with heart conditions in Denmark received some of their medical follow-up care virtually (by phone or video) versus entirely in-person, and whether the type of visit affected whether patients received recommended heart medications. Using nationwide health registry data from 2019 to 2023, the researchers tracked over 100,000 patients diagnosed for the first time with atrial fibrillation (irregular heartbeat), heart failure, pulmonary embolism (blood clot in the lungs), or acute coronary syndrome (heart attack). They found that between roughly one-quarter and one-half of patients received at least some virtual care, depending on their condition, and that this type of care became much more common during the COVID-19 pandemic and stayed common afterward.
The study also found that certain patient characteristics were linked to receiving virtual care. Patients living in cities were more likely to have virtual visits than those in rural areas for most conditions, and patients with higher frailty scores were also more likely to receive virtual care for atrial fibrillation and pulmonary embolism. When it came to starting new recommended heart medications, there were small but measurable differences between virtual and in-person visits — for example, among heart failure patients not already on a key diabetes/heart medication (SGLT-2 inhibitors), about 2.2% started it after a virtual visit compared to about 4.5% after an in-person visit.
This research suggests that virtual care has become a lasting part of how cardiovascular disease is managed in Denmark, but that not all patients are equally likely to use it — with urban residents and, perhaps surprisingly, frailer patients being more likely to receive virtual follow-up. The finding that certain medications were slightly less often started at virtual visits points to a potential area for improvement, as ensuring patients receive guideline-recommended therapies is important regardless of how they are seen by their healthcare team.
Nielsen S, Meddis A, Blanche P, Hashiba M, Schou M, Kirk U, et al.. (2026). Partially Virtual vs In-Person Care in Cardiovascular Conditions-Time Trends, Patient Characteristics, and Medication Management: Cohort Study.. Journal of medical Internet research. https://doi.org/10.2196/94061