Potential of eHealth smart technology in optimization and monitoring of heart failure treatment in adults with systemic right ventricular failure

Abstract

Background Patients with a systemic right ventricle(sRV) in the context of transposition of the great arteries(TGA) after atrial switch or congenitally corrected TGA are prone to heart failure and arrhythmias. This study evaluated feasibility, patient adherence and satisfaction of a smart technology-based care pathway for heart failure treatment optimization in these patients. Methods Patients with symptomatic sRV failure eligible for initiation of sacubitril/valsartan were provided with 4 smart-phone compatible devices (blood pressure monitor, weight scale, step counter, rhythm monitor) and were managed according to a smart technology-based care pathway. Biweekly sacubitril/valsartan titration visits were replaced by electronical visits, patients were advised to continue measurements at least weekly after titration. Results Data of 24 consecutive sRV patients (median age 47 years, 50% female) who participated in the smart technology-based care pathway were analysed. Median home-hospital distance was 65 km(maximum 227 km). Most patients(20, 83.3%) submitted weekly measurements; 100% submitted prior to electronical visits. Titration conventionally occurs during a hospital visit. By implementing eHealth smart technology, 68 such trips to hospital were replaced by virtual visits facilitated by remote monitoring. An eHealth questionnaire was completed by 22 patients(92%), and 96% expressed satisfaction. After titration, thirty instances of remote adjustment of heart failure medication in addition to scheduled outpatient clinic visits occurred, one(4%) heart failure admission followed, despite ambulant adjustments. Five patients(21%) sent in rhythm registrations(n = 17), of these 77% showed sinus rhythm, whereas supraventricular tachycardia was detected in the remaining 4 registrations. Conclusion These data suggest that implementation of a smart technology-based care pathway for optimization of medical treatment sRV failure is feasible with high measurement adherence and patient satisfaction.

Tolerability and beneficial effects of sacubitril/valsartan on systemic right ventricular failure

“…All investigations and outpatient clinic visits were performed as part of a standardised clinical pathway at both participating centres 15. Data were collected from the electronic patient records and included medical history, complaints (a.o.…”

The first experience with sodium‐glucose cotransporter 2 inhibitor for the treatment of systemic right ventricular failure

“…), and a loop diuretic (furosemide 40–80 mg q.d.) and was monitored according to the previously described smart technology‐eHealth based care pathway 5,9 . She adhered to the heart‐failure related diet (salt and fluid) and lifestyle restrictions.…”