Development and implementation of a remote patient monitoring program for heart failure: a single‐centre experience

Abstract

Aims Remote patient monitoring (RPM) in the management of heart failure (HF), including telemonitoring, thoracic impedance, implantable pulmonary artery pressure (PAP) monitors, and cardiac implantable electronic device (CIED)-based sensors, has had varying outcomes in single platform studies. Uncertainty remains regarding the development of single-centre RPM programs; additionally, no studies examine the effectiveness of dual platform RPM programs for HF. This study describes the implementation and outcomes of a dual platform RPM program for HF at a single centre. Methods and results An RPM program was developed to include two platforms (e.g. CardioMEMS ™ HF System and HeartLogic ™ HF Diagnostic). To examine changes within each participant over time, study-related outcomes including total hospitalizations (TH), total length of stay (TLOS), cardiac hospitalizations (CH), cardiac LOS (CLOS), and cardiac-related emergency department (ED) visits were compared in two timeframes: 12 months pre-enrolment and post-enrolment into RPM. For 141 participants enrolled, there was a significant reduction in the likelihood of experiencing a CH by 19% (0.77 vs. 0.61 events/patient-year; HR: 0.81, 95% CI: 0.67-0.97, P = 0.03) and a cardiac-related ED visit by 28% (0.48 vs. 0.34 events/patient-year; HR: 0.72, 95% CI: 0.55-0.93, P = 0.01). There was also a 51% decrease (SE = 1.41, 95% CI: 2.79-8.38 days, P < 0.001) and 62% decrease (SE = 1.24, 95% CI: 3.35-8.22 days, P < 0.001) in TLOS and CLOS, respectively. Conclusions A dual platform RPM program for HF using structured education, RPM-capable devices, and alert-specific medication titration reduces the likelihood of experiencing a cardiac hospitalization and cardiac-related ED visit in this single-centre study.

Remote Cardiac Monitoring in Patients With Heart Failure

“…Few studies report prespecified cut-off values and treatment algorithms. In a study by Baginski et al, an individualized PA diastolic (PAD) pressure goal was established at patient enrollment, usually at a mean (SD) of 15 (3) mm Hg. Based on this, a multitiered treatment plan was formulated, initially titrating guideline-directed medical therapy (GDMT) medications (eg, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 [SGLT2] inhibitors) with the addition of diuretics if PAD pressure did not normalize.…”

“…Based on this, a multitiered treatment plan was formulated, initially titrating guideline-directed medical therapy (GDMT) medications (eg, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 [SGLT2] inhibitors) with the addition of diuretics if PAD pressure did not normalize. Patients with asymptomatic PAD pressure 6 mm Hg greater than the PAD pressure goal were asked to increase their loop diuretic dose by 25% to 50%, while patients with symptomatic PAD pressure more than 6 mm Hg above goal started a short course of thiazide diuretic . Similarly, in the MEMS-HF trial, an actionable PAP threshold was defined, initially set at normal PAP ranges (systolic, 15-35 mm Hg; diastolic, 8-20 mm Hg), and step-wise recommendations were provided to the participating study centers when measurements were above the threshold .…”

Telemedical Monitoring Based on Implantable Devices—the Evolution Beyond the CardioMEMS™ Technology

“…Thus, telemonitoring allows assessing the relevant technical parameters of the device (battery status, electrode function, and system compatibility) and provides other key clinical information (stimulation percentage, arrhythmic episodes, or current intracardiac electrogram) [23,26]. In addition, novel telemetric strategies may provide data on the current clinical status or device alarms, including device-related malfunctions, arrhythmias, heart and respiratory rate statistics, heart sounds, and intrathoracic impedance [28][29][30][31].…”

Scaling-up digital follow-up care services: collaborative development and implementation of Remote Patient Monitoring pilot initiatives to increase access to follow-up care

“…Although RPM pilot design changes on a case-by-case basis, the system should comprise three components: the care team organization, the technology used, and patient engagement activities ( 2 ). Several pilot initiatives emerged from chronic diseases ( 3 ) to episodic care [e.g., surgical follow-ups ( 1 )] to exploit the benefits of RPM, such as, continuity of outpatient care ( 4 ), improved healthcare decision-making ( 1 ), complications anticipation ( 4 ), and cost reduction ( 5 ). In surgical follow-up care, RPM can significantly reduce severe complications and increase patient safety in the most critical period after hospital discharge ( 6 ) by supporting healthcare professionals in the continuous surveillance of clinical and patient-reported outcome measures (PROMs).…”