Abstract Body (Do not enter title and authors here): Introduction
The COVID-19 pandemic led to a lasting increase in telehealth use in the U.S., with 37% of adults reporting use in 2021. This shift has implications for managing cardiovascular risk factors (CRFs), which are prevalent and contribute to growing healthcare burdens. In this population-based study, we examined the association between a composite measure of CRF control and telehealth use, as well as demographic differences and reported reasons for telehealth use by CRF status.

Methods
We analyzed data from the 2022 Health Information National Trends Survey, including adults aged 18+ without prior cardiovascular disease and with complete CRF and telehealth data. A composite CRF score (range 0–7) calculated using the presence of seven risk factors: hypertension, diabetes, smoking, obesity, heavy alcohol use, insufficient physical activity, and sleep. CRF profiles classified as Poor (≥3 risk factors), Average (1–2), or Optimal (0). Weighted logistic regression models estimated the association between CRF status and (1) any telehealth use in the past 12 months, (2) mode and reasons for use among users.

Results
Adults with poor CRF profiles had greater odds of using telehealth than those with optimal profiles (AOR=1.22; 95%CI: 1.03–1.44). Telehealth use was also more likely among females (AOR=1.57; 95%CI: 1.28–1.94), college graduates (AOR=1.91; 95%CI: 1.04–3.48), and insured individuals (AOR=2.52; 95%CI: 1.59–4.00). Those in the Midwest were less likely to use telehealth than Northeastern residents (AOR=0.49; 95%CI: 0.36–0.68). Use increased with CRF burden: 35.7% (optimal), 38.3% (average), and 41.3% (poor). Among users, video visits were more common in those with optimal CRF (74.3% vs. 70.1%) than poor CRF. Minor illness (31.5%) and annual checkups (22.3%) were the most cited reasons among adults with optimal CRF, while chronic illness management (31.7%) was more common in those with poor CRF. Among adults with optimal CRF, education (AOR=2.12; 95%CI: 1.04–4.30) and insurance (AOR=3.18; 95%CI: 1.46–6.90) were strong predictors of use. Females with moderate or poor CRF profiles had higher odds of using telehealth than their male counterparts (AOR=1.65; 95%CI: 1.30–2.09).

Conclusion
Telehealth use is more common among individuals with poor cardiovascular profiles, particularly for chronic condition management, while those with optimal profiles more often used it for preventive care—highlighting telehealth's evolving role in chronic disease management.