First real-world experience with mobile health telemonitoring in adult patients with congenital heart disease

Abstract

BackgroundArrhythmias and heart failure are common and invalidating sequelae in adult patients with congenital heart disease (CHD). Mobile health (m-Health) enables daily monitoring and a timely response that might prevent deterioration. We present an observational prospective registry to evaluate feasibility of an m‑Health telemonitoring program for managing arrhythmia, heart failure and blood pressure in symptomatic adults with CHD.MethodsSymptomatic adult patients with CHD are enrolled in an m‑Health telemonitoring program, which evaluates single-lead ECG, blood pressure and weight measurements. In case of symptoms extra measurements could be performed. Data are collected by mobile apps, matched with individualised thresholds. Patients are contacted if thresholds were exceeded or if arrhythmias were found, for treatment adjustments or reassurance. Data on emergency care utilisation, hospitalisation and patient-reported outcome measures are used to assess quality of life and self-management.Results129 symptomatic CHD patients were invited to participate, 55 participated. Reasons for refusing consent included too time consuming to participate in research (30) and to monitor vital signs (14). At baseline 22 patients were in New York Heart Association class ≥ II heart failure, 43 patients had palpitations or documented arrhythmias, and 8 had hypertension. Mean follow-up was 3.0 months, one patient dropped out, and adherence was 97%.ConclusionThe first results indicate that this program is feasible with high adherence.

Tools to Support Self-Care Monitoring at Home: Perspectives of Patients with Heart Failure

“…One example of leveraging ICT for use in healthcare is telemonitoring, which employs audio, video, and other telecommunication and electronic information processing technology to monitor a patient's status at a distance [9]. Different telemonitoring methods have been used that enable patients at home to consult with healthcare professionals, such as non-invasive telemonitoring or structured telephone support [10], out-patient video consultations [11], and mobile phone apps to transmit vital signs or to titrate HF patient's medication [12,13]. The evidence for non-invasive telemonitoring to support HF patient's self-care is insufficient for the European guidelines' recommendation [5], and issues still need to be resolved concerning funding, criteria for patients, what role skilled healthcare professionals should play, and how to provide service before implementation in clinical practice [14].…”

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

“…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.…”

New developments in adult congenital heart disease

“…In ACHD patients it has been shown that e-health is feasible with high adherence enabling early detection of arrhythmias, hypertension and HF. This may lead to a swift therapeutic response or remote reassurance in case of normal findings [11].…”