Remote monitoring of heart failure: benefits for therapeutic decision making

Abstract

Chronic heart failure is a cardiovascular disorder with high prevalence and incidence worldwide. The course of heart failure is characterized by periods of stability and instability. Decompensation of heart failure is associated with frequent and prolonged hospitalizations and it worsens the prognosis for the disease and increases cardiovascular mortality among affected patients. It is therefore important to monitor these patients carefully to reveal changes in their condition. Remote monitoring has been designed to facilitate an early detection of adverse events and to minimize regular follow-up visits for heart failure patients. Several new devices have been developed and introduced to the daily practice of cardiology departments worldwide. Areas covered: Currently, special tools and techniques are available to perform remote monitoring. Concurrently there are a number of modern cardiac implantable electronic devices that incorporate a remote monitoring function. All the techniques that have a remote monitoring function are discussed in this paper in detail. All the major studies on this subject have been selected for review of the recent data on remote monitoring of HF patients and demonstrate the role of remote monitoring in the therapeutic decision making for heart failure patients. Expert commentary: Remote monitoring represents a novel intensified follow-up strategy of heart failure management. Overall, theoretically, remote monitoring may play a crucial role in the early detection of heart failure progression and may improve the outcome of patients.

The cost impact to Medicare of shifting treatment of worsening heart failure from inpatient to outpatient management settings

“…These devices use various technologies, including bioimpedance, wireless pulmonary artery pressure monitors, and dielectric sensing. These devices have shown to reduce the incidence of HF mortality and inpatient admissions and represent a useful tool in tracking HF patients 22,23. In this context, to be effective, monitoring must also be complemented with effective OP management strategies in the event that disease progression cannot be avoided.…”

Design of the pilot, proof of concept REMOTE-COVID trial: remote monitoring use in suspected cases of COVID-19 (SARS-CoV-2)

“…Progression in non-invasive digital technologies have renewed potential for remote-monitoring solutions [8,9]. Wearable sensors offer an opportunity for sensoralerting systems to continuously monitor vital parameters remotely, recognise early deterioration and support clinical decision making, allowing people to receive monitoring outside of expensive hospital facilities, in resource-limited hospitals, and utilising alternate sites in crisis scenarios [10].…”

Design of the Pilot, Proof of Concept REMOTE-COVID Trial: Remote Monitoring Use in Suspected Cases of COVID-19 (SARS-CoV 2) A Trial Protocol

“…Wearable sensors offer an opportunity for sensor alerting systems to continuously monitor vital parameters remotely, recognise early deterioration and support clinical decision making, allowing people to receive monitoring outside of expensive hospital facilities; in resource limited hospitals; and utilising alternate sites in crisis scenarios. 8 Previous studies have demonstrated acceptability and practicability of continuous monitoring using wearable sensors on general surgical and medical wards in the UK and The Netherlands. 9,10 Initial work by Downey et al were limited by imbalanced randomisation leading to signi cant baseline differences across the two trial arms and failure to adjust for these in their analyses.…”