Emerging Role of Digital Technology and Remote Monitoring in the Care of Cardiac Patients

Banchs, Javier E.; Scher, David M.

doi:10.1016/j.mcna.2015.02.013

Cited by 14 publications

(11 citation statements)

References 104 publications

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“…Conventional telehealth using non-invasive monitoring technologies is being supplemented or superseded by the use of implantable devices, which raise additional clinical, technical, operational and ethical challenges [4, 5, 11, 21, 23, 36, 38, 65, 68]. In some cases, a device is specifically implanted to measure a particular biomarker (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…This vast, complex and statistically daunting literature has been summarised and critiqued in detail elsewhere [5–7, 21, 33, 38, 39, 55, 64, 65, 68, 70]. In this section, we summarise key points from published reviews and consider the question of why so many trials and secondary analyses have produced so few clear recommendations for practice and policy.…”

Section: Resultsmentioning

confidence: 99%

“…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].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Greenhalgh

A’Court

Shaw

2017

BMC Cardiovasc Disord

127

222

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BackgroundEnthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management.MethodsThrough database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell’s hermeneutic methodology for systematic review, which emphasises the quest for understanding.ResultsHeart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by “activated” patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven (“cold”) care. It contrasts with relationship-based (“warm”) care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, “textbook” heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between “cold” and “warm” telehealth; and between fixed and agile care programmes.ConclusionThe limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0594-2) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Greenhalgh

A’Court

Shaw

2017

BMC Cardiovasc Disord

127

222

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“…(Ministerio de Salud Pública de la República del Ecuador, 2013) Con respecto a las nuevas tecnologías que aportan con soluciones para la prevención, detección temprana, diagnóstico y monitorización de enfermedades cardiovasculares, estas se pueden incluir dentro del campo de investigación conocido como U-Health (medicina omnipresente) (Touati & Tabish, 2013). Bajo este concepto se han habilitado redes de monitorización inalámbrica para pacientes en varias instituciones de salud (Banchs & Scher, 2015). Estas redes se conocen como WBAN (Redes de Area Corporal Inalámbrica) y constituyen la siguiente generación de la medicina remota utilizando redes inalámbricas, (Meharouech, Elias, & Mehaoua, 2015).…”

Section: │ 37unclassified

Monitor Cardíaco Portátil con Interfaz Bluetooth “CARDIO UEES” / Portable Heart Monitor with a Bluetooth Interface “CARDIO UEES”

Ruiz

Cardenas²

2016

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ResumenEn este trabajo se presenta el desarrollo e implementación de un monitor cardiaco capaz de cumplir con características de portabilidad, facilidad de uso y tiempo prolongado de operación. El diseño se divide en dos fases. En la primera, cada etapa del monitor cardiaco se implementa priorizando su consumo individual de energía. En la segunda fase, se integran las etapas para conformar el monitor cardiaco, constituido por una fuente de alimentación, una interfaz con el paciente, un micro controlador, una interfaz inalámbrica y una aplicación que se ejecuta en un teléfono inteligente. Para cumplir con las dos fases de diseño se exponen inicialmente los fundamentos teóricos y el desarrollo actual de la monitorización cardiaca. Posteriormente, para cada etapa se describen los requerimientos funcionales y las variables relevantes para su diseño. También se detallan los procesos de implementación y los procedimientos de prueba y sus resultados. Con esta investigación se pretende contribuir con una alternativa de diseño de un monitor cardiaco, que puede utilizarse por un periodo no menor a 30 días. Los resultados demostraron que el equipo desarrollado permite la monitorización cardiaca remota, facilita la movilidad de pacientes y además elimina la necesidad además elimina la necesidad de continuas recargas de energía.Palabras Clave: interfaz inalámbrica; monitor cardiaco; teléfono inteligente. AbstractThis paper describes the development and implementation of a heart monitor capable of meeting portability features, easy to use and a prolonged time of operation. The design is divided into two phases. In the first, each stage of the cardiac monitor is implemented prioritizing their individual energy consumption. In the second phase, the stages are integrated to form the cardiac monitor, consisting of a power supply, an interface with the patient, a micro controller, a wireless interface and an application running on a smartphone. To fulfill the two design phases are initially exposed the theoretical foundations and the current development of cardiac monitoring. Subsequently, for each stage, the functional requirements are described and the relevant variables for the design. Also, implementation processes and test procedures and results are detailed. This research is intended to contribute to an alternative design of a heart monitor, which can be used for not less than 30 days period. The results showed that the equipment developed allows remote cardiac monitoring, facilitates the mobility of patients and also eliminates the need for continuous energy refills.

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“…AHA should take the lead in bridging the theoretical promise of Big Data for clinical investigations and the practical applications of such data. This could include funding for demonstration projects that show how EMRs and other Big Data sources work in a variety of settings and environments . Monitoring disease events and/or medical care in rural areas or in regions with poor resources, for example, may present significant practical barriers to getting high‐quality data from these sources.…”

Section: The American Heart Association's Rolementioning

confidence: 99%

Acquisition, Analysis, and Sharing of Data in 2015 and Beyond: A Survey of the Landscape

Antman¹,

Benjamin²,

Harrington³

et al. 2015

JAHA

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BackgroundA 1.5‐day interactive forum was convened to discuss critical issues in the acquisition, analysis, and sharing of data in the field of cardiovascular and stroke science. The discussion will serve as the foundation for the American Heart Association's (AHA's) near‐term and future strategies in the Big Data area. The concepts evolving from this forum may also inform other fields of medicine and science.Methods and ResultsA total of 47 participants representing stakeholders from 7 domains (patients, basic scientists, clinical investigators, population researchers, clinicians and healthcare system administrators, industry, and regulatory authorities) participated in the conference. Presentation topics included updates on data as viewed from conventional medical and nonmedical sources, building and using Big Data repositories, articulation of the goals of data sharing, and principles of responsible data sharing. Facilitated breakout sessions were conducted to examine what each of the 7 stakeholder domains wants from Big Data under ideal circumstances and the possible roles that the AHA might play in meeting their needs. Important areas that are high priorities for further study regarding Big Data include a description of the methodology of how to acquire and analyze findings, validation of the veracity of discoveries from such research, and integration into investigative and clinical care aspects of future cardiovascular and stroke medicine. Potential roles that the AHA might consider include facilitating a standards discussion (eg, tools, methodology, and appropriate data use), providing education (eg, healthcare providers, patients, investigators), and helping build an interoperable digital ecosystem in cardiovascular and stroke science.ConclusionThere was a consensus across stakeholder domains that Big Data holds great promise for revolutionizing the way cardiovascular and stroke research is conducted and clinical care is delivered; however, there is a clear need for the creation of a vision of how to use it to achieve the desired goals. Potential roles for the AHA center around facilitating a discussion of standards, providing education, and helping establish a cardiovascular digital ecosystem. This ecosystem should be interoperable and needs to interface with the rapidly growing digital object environment of the modern‐day healthcare system.

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Emerging Role of Digital Technology and Remote Monitoring in the Care of Cardiac Patients

Cited by 14 publications

References 104 publications

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Monitor Cardíaco Portátil con Interfaz Bluetooth “CARDIO UEES” / Portable Heart Monitor with a Bluetooth Interface “CARDIO UEES”

Acquisition, Analysis, and Sharing of Data in 2015 and Beyond: A Survey of the Landscape

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