Advantages of mobile health in the management of adult patients with congenital heart disease

Kauw, Dirkjan; Koole, M. A. C.; Winter, Michiel M.; Dohmen, Daan; Tulevski, Igor I.; Blok, Sebastiaan; Somsen, G. Aernout; Schijven, Marlies P.; Vriend, Joris W.J.; Robbers‐Visser, Daniëlle; Mulder, Barbara J.M.; Bouma, Berto J.; Schuuring, Mark J.

doi:10.1016/j.ijmedinf.2019.104011

Cited by 32 publications

(37 citation statements)

References 16 publications

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“…Remote monitoring (Alivecor Kardia Mobile, Cardiacsense) devices may offer better tools to detect rhythm change than the temporally limited nature of clinic detection or Holter monitoring [ 25 ]. Similarly, given the difficulty in assessing function of complex cardiac morphologies, biomarkers such as NT-BNP and serial weight assessment may screen and monitor therapy more effectively for heart failure than echocardiography [ 26 , 27 ]. New technologies will further expand opportunities for mobile health [ 28 ], in the same way that home and online blood pressure monitoring has proven to achieve better hypertension control than traditional approaches [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Coats

Chaudhry

2022

JCM

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Background: The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. Methods: A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020–July 2021). Results: Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6–265), resulting in 433–564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. Conclusion: The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.

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Section: Discussionmentioning

confidence: 99%

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Coats

Chaudhry

2022

JCM

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“…The most common deficiencies in methodological quality were for the domains of competing interests and sources of support, statistical analysis and study design. Two studies 21,22 provided details on competing interests and sources of support, with the remaining four studies [23][24][25][26] not providing any information in relation to this. The domain for statistical analysis also identified three studies [23][24][25] which were judged to have a low level of quality based on the IHE quality appraisal checklist.…”

Section: Ihe Quality Appraisal Checklistmentioning

confidence: 99%

A systematic review examining the clinical and health-care outcomes for congenital heart disease patients using home monitoring programmes

et al. 2021

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Objectives This review aimed to present the clinical and health-care outcomes for patients with congenital heart disease (CHD) who use home monitoring technologies. Methods Five databases were systematically searched from inception to November 2020 for quantitative studies in this area. Data were extracted using a pre-formatted data-collection table which included information on participants, interventions, outcome measures and results. Risk of bias was determined using the Cochrane Risk of Bias 2 tool for randomised controlled trials (RCTs), the Newcastle–Ottawa Quality Assessment Scale for cohort studies and the Institute of Health Economics quality appraisal checklist for case-series studies. Data synthesis: Twenty-two studies were included in this systematic review, which included four RCTs, 12 cohort studies and six case-series studies. Seventeen studies reported on mortality rates, with 59% reporting that home monitoring programmes were associated with either a significant reduction or trend for lower mortality and 12% reporting that mortality trended higher. Fourteen studies reported on unplanned readmissions/health-care resource use, with 29% of studies reporting that this outcome was significantly decreased or trended lower with home monitoring and 21% reported an increase. Impact on treatment was reported in 15 studies, with 67% of studies finding that either treatment was undertaken significantly earlier or significantly more interventions were undertaken in the home monitoring groups. Conclusion The use of home monitoring programmes may be beneficial in reducing mortality, enabling earlier and more timely detection and treatment of CHD complication. However, currently, this evidence is limited due to weakness in study designs.

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“…All patients who participated were enrolled in a Dutch telemonitoring programme, which monitored weight, blood pressure and heart rhythm. 29 Cardiac patients who were currently or previously enrolled in the telemonitoring programme were identified through the outpatient clinic. We aimed to enrol equal numbers of cardiac patients, healthcare professionals, managers and ICT developers to provide an overarching view on experiences and challenges of all stakeholders involved in mHealth.…”

Section: Participantsmentioning

confidence: 99%

Mobile health in cardiac patients: an overview on experiences and challenges of stakeholders involved in daily use and development

et al. 2020

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BackgroundMobile health (mHealth) can improve quality of care and empower cardiac patients. However, large-scale adoption is still lacking, as several challenges continue to be encountered in daily practice. We aimed to explore the mHealth experiences and challenges in cardiac patients, healthcare professionals, healthcare managers and information and communications technology (ICT) developers.MethodsA qualitative research was employed where semistructured interviews were conducted in patients, healthcare professionals, managers and ICT developers. We aimed to enrol participants of every stakeholder group, with diversity in sex, age group and occupation. Thematic analysis was used to identify themes reflecting experiences and challenges in mHealth in cardiac patients.ResultsIn total, 24 interviews were conducted in six patients, eight healthcare professionals, five managers and five ICT developers. Monitoring/care at home was reported as important advantage of mHealth (n=20, 83%). Patients valued increase of self-care (n=6, 100%) and remote reassurance (n=6, 100%), but reported medicalisation as important concern (n=4, 67%). Healthcare professionals warned for increased data burden (n=4, 50%). Managers agreed on the importance of device reliability (n=5, 100%) and ICT developers emphasised that the goal of mHealth is to replace care, rather than being supplementary (n=4, 80%). The majority of all participants (n=22, 92%) considered future use of mHealth as promising.ConclusionsAll stakeholders foresee benefit of mHealth in cardiac patients, especially for remote care and reassurance. Frequently mentioned challenges included the need to replace care with mHealth, rather than adding more workload, and employing reliable devices and applications. If collaboration can be improved and group-specific challenges overcome, success of mHealth in cardiac patients can improve significantly.

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Advantages of mobile health in the management of adult patients with congenital heart disease

Cited by 32 publications

References 16 publications

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

A systematic review examining the clinical and health-care outcomes for congenital heart disease patients using home monitoring programmes

Mobile health in cardiac patients: an overview on experiences and challenges of stakeholders involved in daily use and development

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