eHealth in cardiovascular medicine: A clinical update

Abstract

Demographic changes, progress in medicine technology and regional problems in providing healthcare to low density populations are posing great challenges to our healthcare systems. Rapid progress in computer sciences and information technologies have a great impact on the way healthcare will be delivered in the near future. This article describes opportunities and challenges of eHealth and telemedicine in the framework of our health systems and, in particular, in the context of today's cardiology services. The most promising applications of eHealth and telemedicine include: (a) prevention and lifestyle interventions; (b) chronic disease management including hypertension, diabetes and heart failure; (c) arrhythmia detection including early detection of atrial fibrillation and telemonitoring of devices such as pacemaker, internal cardioverter defibrillators and implantable rhythm monitoring devices; (d) telerehabilitation. Major obstacles to the integration of eHealth and telemedicine into daily clinical practice include limited large-scale evidence, in particular, for cost-effectiveness, as well as lack of interoperability, inadequate or fragmented legal frameworks and lack of reimbursement. An important challenge for those involved in these new technologies will be to keep the main focus on patient's individual needs and to carefully evaluate the evidence behind the practice.

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

“…She quickly identified a sample of highly-cited review articles covering both quantitative and qualitative research [5, 7, 17, 21, 38, 52, 65, 68–70]. She used citation tracking in Google Scholar to identify subsequent articles that had cited these seminal sources [71].…”

“…The use of telehealth technology in heart failure management remains controversial, with some clinicians and policymakers strongly enthusiastic [1–4] and others unconvinced or opposed [5–7]. Despite dozens of randomised controlled trials (including several megatrials [8–13]), over 20 systematic reviews and meta-analyses of clinical trials [14–33] and (at last count) 7 systematic reviews of systematic reviews [6, 34–39], as well as studies of cost-effectiveness [21, 40–43], the patient experience [18, 24, 44–47] and service organisation [32, 48–51], there is limited agreement on which outcomes matter; the extent to which telehealth adds benefit over usual care; how best (if at all) to change service models to support telehealth; and whether and in what circumstances telehealth is cost-effective.…”

“…In the context of high and rising prevalence of heart failure [52–54] and its unenviable position atop the league table of reasons for hospital readmission [55], recruitment of heart failure patients to clinical trials of telehealth is consistently poor [17, 32, 56–58]; roll-out and scale-up of telehealth services for heart failure in real-world settings is slow [32, 49, 59–63]; and robust business models are lacking [5]. Systematic reviews and meta-analyses have been criticised for major methodological flaws [6, 33, 36, 38, 39, 64, 65] and economic evaluations for their questionable and/or unstated assumptions [42].…”

Screening after hypertensive pregnancy disorders: She can do best

“…The use of modern eHealth applications to monitor BP at home intensifies patient involvement and increases motivation for healthy lifestyle adherence and better intake of prescribed medication. 11 This needs to be further explored in this potentially very suitable patient group.…”

Editor’s presentation

“…18 The arrival on the market of PA sensors (pedometers, accelerometers, global positioning system) has facilitated the continuous out-of-hospital measurement of the amount of PA of both healthy subjects and patients. 19 However, it is here demonstrated that wearable sensors are not accurate enough and underestimate the actual energy expenditure values in post-stroke patients in the subacute phase. 20 However, they may still play a role in stimulating adherence to prescribed PA.…”