Remote Monitoring of Heart Failure Patients

Abstract

A. Bhimaraj, M.D., M.P.H. (Tele, far; Dactyl, finger - "The Teledactyl AbstractHeart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor.

Home telehealth in older patients with heart failure – costs, adherence, and outcomes

“…Moreover, there is a global trend of individuals being more and more interested in self-managing their health and willing to age at home, rather than in an institution. 2 At the same time, most of the available research reports 3 and studies [4][5][6] claim that, despite a necessary significant financial investment at a first stage, the adoption of information and communication technologies (ICT), in the delivery of remote health services to populations, can really enable strong savings while preserving quality and efficacy of services and treatments. In the broader field of telemedicine and/or telehealth, several solutions and systems have been conceived and implemented in various forms over many years; telehomecare or home telehealth 7 is often merged with different approaches, such as those related to Ambient Assisted Living.…”

“…As a general remark, for any possible telehealth service and architecture to be designed, a large literature of similar or comparable experiences exists and can provide useful insights about possible advantages and disadvantages and provisional and forecast data about expected outcomes and impact on patients. Many comprehensive overviews of possible monitoring approaches for HF, from structured telephone monitoring to monitoring with home-based portable technology or specially designed wearable and implantable devices, are available in the literature, such as in the study by Bhimaraj,6 or about the specific components of the homecare intervention, such as in the study by Jaarsma et al 20 Suitably designed (ie, compliant, user-friendly, safe) devices for RPM have been shown to increase the patients' role in the management of their own health, improve chronic disease management, and reduce the incidence of acute episodes. By using a variety of integrated or standalone RPM devices, up-to-date information on patients' chronic disease and/or post-acute care status (including vital signs, heart rate, blood glucose levels, medication management, mental health, physical and cognitive fitness), and other data (such as patient's location, or ambient parameters) can be transmitted to family caregivers, providers, or third parties in charge of patient monitoring.…”

Recent Advances in the Optimization of Cardiac Resynchronization Therapy

“…Remote follow-up using intracardiac devices for early detection of fluid overload monitors thoracic impedance and predicts stroke volume to predict hospitalization due to acute HF [50][51][52]. Intrathoracic impedance and intravascular fluid status have an inverse relation which can notify the provider of impending exacerbations, dehydration, and bleeding events.…”

Early Warning of Acute Decompensation in Heart Failure Patients Using a Noncontact Measure of Stability Index

“…HF disease management programmes are in place to educate patients to identify symptoms and signs of deterioration, such as weight gain or increased breathlessness [4]. With home monitoring, clinicians can identify early warning signs of fluid retention and intervene as needed, either by reinstating adherence to optimal diet and medications or by increasing diuretic dosage to avoid worsening of symptoms [5].…”