Leveraging Remote Physiologic Monitoring in the COVID-19 Pandemic to Improve Care After Cardiovascular Hospitalizations

Dey, Pranam; Jarrin, Robert; Mori, Makoto; Geirsson, Arnar; Krumholz, Harlan M.

doi:10.1161/circoutcomes.120.007618

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…Although personal digital device and PROM data are not commonly a part of routine clinical care because of a lack of EHR integration, Medicare has augmented reimbursement for remote patient monitoring, and treatment paradigms may increase use. 31 , 32 , 33 Future research analyzing larger samples and more granular personal digital device data may further elucidate meaningful associations with patient outcomes and guide clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Physical activity, patient-reported symptoms, and clinical events: Insights into postprocedural recovery from personal digital devices

Bartlett

Ross

Shah

et al. 2021

Cardiovascular Digital Health Journal

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Physical activity, patient-reported symptoms, and clinical events: Insights into postprocedural recovery from personal digital devices

Bartlett

Ross

Shah

et al. 2021

Cardiovascular Digital Health Journal

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“…Furthermore, their financial feasibility is highlighted by recent policy changes by the Centers for Medicare & Medicaid Services, which has helped broaden reimbursement for digital health tools involved in remote patient monitoring. 40 , 41 …”

Section: Discussionmentioning

confidence: 99%

Heart rate trajectories in patients recovering from acute myocardial infarction: A longitudinal analysis of Apple Watch heart rate recordings

Weng

Ding

Sharma

et al. 2021

Cardiovascular Digital Health Journal

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BACKGROUND Using mobile health, vital signs such as heart rate (HR) can be used to assess a patient's recovery process from acute events including acute myocardial infarction (AMI).OBJECTIVE We aimed to characterize clinical correlates associated with HR change in the subacute period among patients recovering from AMI.METHODS HR measurements were collected from 91 patients (4447 HR recordings) enrolled in the MiCORE study using the Apple Watch and Corrie smartphone application. Mixed regression models were used to estimate the associations of patient-level characteristics during hospital admission with HR changes over 30 days postdischarge. RESULTSThe mean daily HR at admission was 78.0 beats per minute (bpm) (95% confidence interval 76.1-79.8), declining 0.2 bpm/day (20.3 to 20.1). Patients with prior coronary artery bypass graft (CABG) had higher admission HR (8.4 bpm more than those without, 0.9-15.9) and an increasing HR over 30 days (0.3 bpm/ day more than those without, 0.01-0.7). Patients without prior CABG demonstrated a downward trend in HR. Having a history of hypertension or type 2 diabetes mellitus (T2DM) was each associated with a slower decrease in HR over time, but not with HR during admission.CONCLUSION While a declining HR was observed in AMI patients over 30 days postdischarge, patients with prior CABG had an increasing HR compared to a downward trend observed in those without. Having hypertension or T2DM showed a slower decrease in HR relative to their counterparts. This study demonstrates the feasibility of using wearables to model the recovery process of patients with AMI and represents a first step in helping pinpoint patients vulnerable to decompensation.

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“…21 Third, recent policy changes by Medicare provide reimbursement for remote patient monitoring using personal digital devices and this study will provide information about the implications of these changes. 27 28…”

Section: Discussionmentioning

confidence: 99%

Apple Watch and Withings Evaluation of Symptoms, Treatment, and Rhythm in those Undergoing Cardioversion (AWE STRUCk): A Pragmatic Randomized Controlled Trial

Dhruva

Shah

Vemulapalli

et al. 2021

Preprint

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Introduction: Personal digital devices that provide health information, such as the Apple Watch, have developed an increasing array of cardiopulmonary tracking features which have received regulatory clearance and are directly marketed to consumers. Despite their widespread and increasing use, data about the impact of personal digital device use on patient-reported outcomes and healthcare utilization are sparse. Among a population of patients with atrial fibrillation undergoing cardioversion, our primary aim is to determine the impact of the heart rate measurement, irregular rhythm notification, and electrocardiogram features of the Apple Watch on quality of life and healthcare utilization. Methods and analysis: We are conducting a prospective, open-label multicenter pragmatic randomized clinical trial, leveraging a unique patient-centered health data sharing platform for enrollment and follow-up. A total of 150 patients undergoing cardioversion for atrial fibrillation (or atrial flutter, if they have a history of atrial fibrillation) will be randomized 1:1 to receive the Apple Watch Series 6 or Withings Move at the time of cardioversion. The primary outcome is the difference in the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) global score at six months post-cardioversion. Secondary outcomes include inpatient and outpatient healthcare utilization. Additional secondary outcomes include a comparison of the Apple Watch ECG and pulse oximeter features with gold standard data obtained in routine clinical care settings. Ethics and dissemination: The Institutional Review Boards at Yale University, Mayo Clinic, and Duke University Health System have approved the trial protocol. This trial will provide important data to policymakers, clinicians, and patients about the impact of the heart rate, irregular rhythm notification, and electrocardiogram features of widely used personal digital devices on patient quality of life and healthcare utilization. Findings will be disseminated to study participants, at professional society meetings, and in peer-reviewed journals.

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Leveraging Remote Physiologic Monitoring in the COVID-19 Pandemic to Improve Care After Cardiovascular Hospitalizations

Cited by 6 publications

References 3 publications

Physical activity, patient-reported symptoms, and clinical events: Insights into postprocedural recovery from personal digital devices

Physical activity, patient-reported symptoms, and clinical events: Insights into postprocedural recovery from personal digital devices

Heart rate trajectories in patients recovering from acute myocardial infarction: A longitudinal analysis of Apple Watch heart rate recordings

Apple Watch and Withings Evaluation of Symptoms, Treatment, and Rhythm in those Undergoing Cardioversion (AWE STRUCk): A Pragmatic Randomized Controlled Trial

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