The Clinical Impact and Good Practices of Remote Patient Monitoring for Chronic Heart Failure: A French Case Report

Abstract

Remote patient monitoring (RPM) can improve the management of chronic diseases. Since 2019, RPM in chronic heart failure (CHF) management has been internationally supported. However, evidence on the clinical impact and good practices of RPM is scarce. We present a case of a patient with CHF that used RPM in France. Patients and Methods: A 74-year-old male was diagnosed with CHF (NYHA I) at the AP-HP Cochin Hospital in January 2020. He faced repetitive hospitalizations for acute heart failure and acute kidney injury. The causes of these acute episodes were unknown. Three therapeutic interventions were implemented (diuretic treatment, RPM and therapeutic education sessions). The patient answered questionnaires regularly and directly through the RPM web application named Satelia ® Cardio. Therapeutic education was provided to instruct the patient about his symptoms and treatment management. Results: Since November 11, 2020, the patient had seven hospitalizations representing a total length of stay of 76 days over a period of 15 months and 2 weeks. Pericarditis was diagnosed as a potential cause and a pre-operative checkup was performed. No tangible benefits were found with diuretic treatment and therapeutic education since they had no effect on stopping the acute episodes leading to hospitalization. RPM did not trigger any clinical alerts until his last hospitalization. During this stay, a clinical telehealth nurse reviewed the patient's clinical setup and found that his initial baseline weight was incorrectly inputted. Since amending this, there were no new episodes. A high-risk, complex and costly heart surgery for pericardial decortication was avoided, and patient satisfaction has increased. Conclusion:To respect good practices, inclusion not only involves adding or registering a patient to a telehealth activity and database but involves redesigning the management and pathway of patients in order to conduct periodic and personalized clinical care via integrated technology into routine care.