Mobile health and implantable cardiac devices: Patients' expectations

Abstract

Background Mobile computing and communication technologies in health services and information (so-called mHealth) have modified the traditional approach in the follow-up of patients with implantable cardiac devices, increased patient engagement and empowerment, reduced healthcare costs and improved patients' outcome. Recent developments in mobile technology, with the introduction of smartphone-compatible devices that can measure various health parameters and transfer automatically generated data, have increased the potential application of remote monitoring and the interest towards mHealth. However, little is known about the patients' interest and expectations of this new technology. Objective The patients' interest in the possibility of receiving data from their implantable cardiac device, clinical and health advice via remote monitoring on their smartphones were investigated. Methods A questionnaire entitled ‘Expectations for future possibility of self-management of device data’ (Likert scale scored) was submitted to 300 consecutive implantable cardiac device outpatients. The questionnaire was focused on collecting patients’ expectations in receiving direct information regarding their implantable cardiac device status (item 1, five questions), their own clinical status (item 2, seven questions) and advice on healthy lifestyle promotion (item 3, nine questions). Patient characteristics associated with greater interest towards mHealth were also investigated. Results Questionnaires were completed by 268 patients (221 men, aged 69 ± 14 years). The Cronbach test reported an alpha value of 0.98 for item 1, 0.94 for item 2 and 0.97 for item 3. Patients declared to be mainly interested in the device interventions (62%) and in severe arrhythmia occurrence (61%), followed by data on heart failure severity (54%) and their performed physical activity (48%). Patients showed very little interest in ECG tracing (37%), but the lowest interest was expressed towards healthy lifestyle promotion advice (<40%). A higher education degree and the presence of the caregiver positively affected the interest towards remote monitoring information ( P < 0.001). Conclusions The patients' interests were mainly directed at receiving information related to technical data of the implantable cardiac device and not to the overall management of the disease, underlying the insufficient awareness of patients towards the key role of self-control health status and the promotion of a healthy lifestyle.

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

“…105 Patients with implanted devices (such as implantable cardioverter defibrillator or cardiac resynchronisation systems) showed little interest in receiving dedicated information on the overall management of their disease, underlying the insufficient awareness of patients towards the key role of self-control health status and the promotion of a healthy lifestyle. 106…”

Editor’s presentation: ‘Les liaisons dangereuses. The heart in the time of COVID-19’

“…The results of this study can be interpreted as our failure as healthcare providers to educate patients and encourage behaviour associated with a healthy lifestyle. 10 Moreover, a system is required that targets patients who are more likely to exhibit at-risk behaviours, providing them with sufficient information and stimuli to maximise engagement. 1,11 Remnant cholesterol and residual cardiovascular risk Despite achieving optimal low-density lipoprotein cholesterol levels, the residual cardiovascular risk has been attributed to triglyceride-rich lipoproteins and their cholesterol content, known as remnant cholesterol (RC).…”

“…The results of this study can be interpreted as our failure as healthcare providers to educate patients and encourage behaviour associated with a healthy lifestyle. 10 Moreover, a system is required that targets patients who are more likely to exhibit at-risk behaviours, providing them with sufficient information and stimuli to maximise engagement. 1,11…”

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“…This topic has not been largely studied and here, just in time, comes the study by Villani et al, published in this issue of the journal. 10 It is the first study assessing the patients' interests with regard to the feasibility of a direct interaction between their ICD via RM technology and m-Health (smartphone app) as well as their acceptance of this technology, and determining which specific information may be perceived as most important to be delivered.…”