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Huecker M, Schutzman C, French J, El-Kersh K, Ghafghazi S, Desai R, Frick D, Thomas JJ. Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation: Prospective Case-Control Study. JMIR Cardio 2024; 8:e57111. [PMID: 38924781 PMCID: PMC11237790 DOI: 10.2196/57111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients. OBJECTIVE This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone. METHODS This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness. RESULTS Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3% (43/113) of the group. Using an EF cutoff of ≤40% versus >40%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion. CONCLUSIONS This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist.
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Affiliation(s)
- Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Craig Schutzman
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Joshua French
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Karim El-Kersh
- Department of Pulmonary and Critical Care Medicine, The University of Arizona, Phoenix, AZ, United States
| | - Shahab Ghafghazi
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ravi Desai
- Lehigh Valley Health Network Cardiology and Critical Care, Allentown, PA, United States
| | - Daniel Frick
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Jarred Jeremy Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
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Pagano M, Corallo F, Anselmo A, Giambò FM, Micali G, Duca A, D’Aleo P, Bramanti A, Garofano M, Bramanti P, Cappadona I. Optimisation of Remote Monitoring Programmes in Heart Failure: Evaluation of Patient Drop-Out Behaviour and Healthcare Professionals' Perspectives. Healthcare (Basel) 2024; 12:1271. [PMID: 38998806 PMCID: PMC11241166 DOI: 10.3390/healthcare12131271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Heart failure (HF) is a growing epidemic, affecting millions of people worldwide, and is a major cause of mortality, morbidity, and impaired quality of life. Traditional cardiac rehabilitation is a valuable approach to the physical and quality-of-life recovery of patients with cardiovascular disease. The innovative approach of remote monitoring through telemedicine offers a solution based on modern technologies, enabling continuous collection of health data outside the hospital environment. Remote monitoring devices present challenges that could adversely affect patient adherence, resulting in the risk of dropout. By applying a cognitive-behavioral model, we aim to identify the antecedents of dropout behavior among patients adhering to traditional cardiac rehabilitation programs and remote monitoring in order to improve the latter. Our study was conducted from October 2023 to January 2024. In the first stage, we used data from literature consultation. Subsequently, data were collected from the direct experience of 49 health workers related to both remote monitoring and traditional treatment, recruited from the authors' workplace. Results indicate that patients with cardiovascular disease tend to abandon remote monitoring programs more frequently than traditional cardiac rehabilitation therapies. It is critical to design approaches that take these barriers into account to improve adherence and patient satisfaction. This analysis identified specific antecedents to address, helping to improve current monitoring models. This is crucial to promote care continuity and to achieve self-management by patients in the future.
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Affiliation(s)
- Maria Pagano
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Anna Anselmo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Fabio Mauro Giambò
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Giuseppe Micali
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Antonio Duca
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Piercataldo D’Aleo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marina Garofano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
- Faculty of Psychology, Università degli Studi eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
| | - Irene Cappadona
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
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Manavi T, Zafar H, Sharif F. An Era of Digital Healthcare-A Comprehensive Review of Sensor Technologies and Telehealth Advancements in Chronic Heart Failure Management. SENSORS (BASEL, SWITZERLAND) 2024; 24:2546. [PMID: 38676163 PMCID: PMC11053658 DOI: 10.3390/s24082546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Heart failure (HF) is a multi-faceted, complex clinical syndrome characterized by significant morbidity, high mortality rate, reduced quality of life, and rapidly increasing healthcare costs. A larger proportion of these costs comprise both ambulatory and emergency department visits, as well as hospital admissions. Despite the methods used by telehealth (TH) to improve self-care and quality of life, patient outcomes remain poor. HF management is associated with numerous challenges, such as conflicting evidence from clinical trials, heterogeneity of TH devices, variability in patient inclusion and exclusion criteria, and discrepancies between healthcare systems. A growing body of evidence suggests there is an unmet need for increased individualization of in-hospital management, continuous remote monitoring of patients pre and post-hospital admission, and continuation of treatment post-discharge in order to reduce re-hospitalizations and improve long-term outcomes. This review summarizes the current state-of-the-art for HF and associated novel technologies and advancements in the most frequently used types of TH (implantable sensors), categorizing devices in their preclinical and clinical stage, bench-to-bedside implementation challenges, and future perspectives on remote HF management to improve long-term outcomes of HF patients. The Review also highlights recent advancements in non-invasive remote monitoring technologies demonstrated by a few pilot observational prospective cohort studies.
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Affiliation(s)
- Tejaswini Manavi
- Cardiovascular Translational Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland; (T.M.); (F.S.)
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Translational Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland; (T.M.); (F.S.)
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- College of Science and Engineering, University of Galway, H91 TK33 Galway, Ireland
| | - Faisal Sharif
- Cardiovascular Translational Research & Innovation Centre, University of Galway, H91 TK33 Galway, Ireland; (T.M.); (F.S.)
- Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Department of Cardiology, University Hospital Galway, H91 YR71 Galway, Ireland
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Riegel B, Dickson VV, Vellone E. The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care. J Cardiovasc Nurs 2022; 37:515-529. [PMID: 35482335 PMCID: PMC9561231 DOI: 10.1097/jcn.0000000000000919] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care. OBJECTIVE The aim of this study was to describe the manner in which characteristics of the problem, person, and environment interact to influence decisions about self-care made by adults with chronic HF. METHODS This study is a theoretical update. Literature on the influence of the problem, person, and environment on HF self-care is summarized. RESULTS Consistent with naturalistic decision making, the interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF self-care include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy. CONCLUSIONS A robust body of knowledge has accumulated on the person-related factors influencing HF self-care. More research on the contribution of problem-related factors to HF self-care is needed because very few people have only HF and no other chronic conditions. The research on environment-related factors is particularly sparse. Seven new propositions are included in this update. We strongly encourage investigators to consider the interactions of problem, person, and environmental factors affecting self-care decisions in future studies.
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Morales-Botello ML, Gachet D, de Buenaga M, Aparicio F, Busto MJ, Ascanio JR. Chronic patient remote monitoring through the application of big data and internet of things. Health Informatics J 2021; 27:14604582211030956. [PMID: 34256646 DOI: 10.1177/14604582211030956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chronic patients could benefit from the technological advances, but the clinical approaches for this kind of patients are still limited. This paper describes a system for chronic patients monitoring both, in home and external environments. For this purpose, we used novel technologies as big data, cloud computing and internet of things (IoT). Additionally, the system has been validated for three use cases: cardiovascular disease (CVD), hypertension (HPN) and chronic obstructive pulmonary disease (COPD), which were selected for their incidence in the population. This system is innovative within e-health, mainly due to the use of a big data architecture based on open-source components, also it provides a scalable and distributed environment for storage and processing of biomedical sensor data. The proposed system enables the incorporation of non-medical data sources in order to improve the self-management of chronic diseases and to develop better strategies for health interventions for chronic and dependents patients.
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Papoutsi C, A'Court C, Wherton J, Shaw S, Greenhalgh T. Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework. Trials 2020; 21:891. [PMID: 33109254 PMCID: PMC7590600 DOI: 10.1186/s13063-020-04817-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The SUPPORT-HF2 randomised controlled trial compared telehealth technology alone with the same technology combined with centralised remote support, in which a clinician responds promptly to biomarker changes. The intervention was implemented differently in different sites; no overall impact was found on the primary endpoint (proportion of patients on optimum treatment). We sought to explain the trial's findings in a qualitative evaluation. METHODS Fifty-one people (25 patients, 3 carers, 18 clinicians, 4 additional researchers) were interviewed and observed in 7 UK trial sites in 2016-2018. We collected 110 pages of documents. The analysis was informed by the NASSS framework, a multi-level theoretical lens which considers non-adoption and abandonment of technologies by individuals and challenges to scale-up, spread and sustainability. In particular, we used NASSS to tease out why a 'standardised' socio-technical intervention played out differently in different sites. RESULTS Patients' experiences of the technology were largely positive, though influenced by the nature and severity of their illness. In each trial site, existing services, staffing levels, technical capacity and previous telehealth experiences influenced how the complex intervention of 'telehealth technology plus centralised specialist remote support' was interpreted and the extent to which it was adopted and used to its full potential. In some sites, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. Elsewhere, the new model was actively resisted and the technology little used. In one site, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. CONCLUSIONS Complex socio-technical interventions, even when implemented in a so-called standardised way with uniform inclusion and exclusion criteria, are inevitably implemented differently in different local settings because of how individual staff members interpret the technology and the trial protocol and because of the practical realities and path dependencies of local organisations. Site-specific iteration and embedding of a new technology-supported complex intervention may be required (in addition to co-design of the user interface) before such interventions are ready for testing in clinical trials. TRIAL REGISTRATION BMC ISRCTN Registry 86212709 . Retrospectively registered on 5 September 2014.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Planinc I, Milicic D, Cikes M. Telemonitoring in Heart Failure Management. Card Fail Rev 2020; 6:e06. [PMID: 32377385 PMCID: PMC7199128 DOI: 10.15420/cfr.2019.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022] Open
Abstract
Telemonitoring (TM) aims to predict and prevent worsening heart failure (HF) episodes and improve self-care, patient education, treatment adherence and survival. There is a growing number of TM options for patients with HF, but there are numerous challenges in reaching positive outcomes. Conflicting evidence from clinical trials may be the result of the enormous heterogeneity of TM devices tested, differences in selected patient populations and variabilities between healthcare systems. This article covers some basic concepts of TM, looking at the recent advances in the most frequently used types of TM and the evidence to support its use in the care of people with HF.
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Affiliation(s)
- Ivo Planinc
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
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Ware P, Ross HJ, Cafazzo JA, Boodoo C, Munnery M, Seto E. Outcomes of a Heart Failure Telemonitoring Program Implemented as the Standard of Care in an Outpatient Heart Function Clinic: Pretest-Posttest Pragmatic Study. J Med Internet Res 2020; 22:e16538. [PMID: 32027309 PMCID: PMC7055875 DOI: 10.2196/16538] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/17/2019] [Accepted: 01/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decisions. The Medly program enables patients to use a mobile phone to record daily HF readings and receive personalized self-care messages generated by a clinically validated algorithm. The TM system also generates alerts, which are immediately acted upon by the patients’ existing care team. This program has been operating for 3 years as part of the standard of care in an outpatient heart function clinic in Toronto, Canada. Objective This study aimed to evaluate the 6-month impact of this TM program on health service utilization, clinical outcomes, quality of life (QoL), and patient self-care. Methods This pragmatic quality improvement study employed a pretest-posttest design to compare 6-month outcome measures with those at program enrollment. The primary outcome was the number of HF-related hospitalizations. Secondary outcomes included all-cause hospitalizations, emergency department visits (HF related and all cause), length of stay (HF related and all cause), and visits to the outpatient clinic. Clinical outcomes included bloodwork (B-type natriuretic peptide [BNP], creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. QoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 5-level EuroQol 5-dimensional questionnaire. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). The difference in outcome scores was analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables. Results Available data for 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (incidence rate ratio [IRR]=0.50; P<.001) and a 24% decrease in the number of all-cause hospitalizations (IRR=0.76; P=.02) were found when comparing the number of events 6 months after program enrollment with the number of events 6 months before enrollment. With regard to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. Moreover, 6-month MLHFQ total scores were 9.8 points lower than baseline scores (P<.001), representing a clinically meaningful improvement in HF-related QoL. Similarly, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (P<.001) and 1.5 points (P=.04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (P<.001) and 8.5-point (P=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes. Conclusions This study suggests that an HF TM program, which provides patients with self-care support and active monitoring by their existing care team, can reduce health service utilization and improve clinical, QoL, and patient self-care outcomes.
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Affiliation(s)
- Patrick Ware
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Chris Boodoo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mikayla Munnery
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Mareev YV, Zinchenko AO, Myasnikov RP, Vakhovskaya TV, Andreenko EY, Boytsov SA, Drapkina OM. [Telemonitoring in patients with chronic heart failure]. ACTA ACUST UNITED AC 2019; 59:4-15. [PMID: 31644412 DOI: 10.18087/cardio.n530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022]
Abstract
Actuality. High risk of hospitalisation and death in patients with heart failure highlight the importance of developing methods to moni‑ tor weight, diuresis, heart rate and other parameters and provide the physicians with an ability to change the therapy immediately if needed. The aim of this work is an analysis of clinical trials which investigate telemonitoring in patients with heart failure. Discussion. The Cochrane meta-analysis is also discussed in this work. Main conclusions. Our analysis showed that there is no consistency among trials. Not all trials have demonstrated that telemonitoring can reduce the risk of death and heart failure hospitalisations. Potentials explanations are lack of compliance with systems which didn't include the direct contact between the patient and the caregivers, using parameters with low sensitivity in some of the methods and including of stable patients in some of the studies. It is also seeming that effect of telemonitoring is low in regions with existing programs to treat heart failure.
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Affiliation(s)
- Yu V Mareev
- National Research Center for Preventive Medicine
| | | | | | | | | | - S A Boytsov
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - O M Drapkina
- National Research Center for Preventive Medicine
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Anosike C, Adibe MO, Isah A, Ukoha-Kalu OB. Willingness to pay for pharmacist-provided home telemonitoring among patients with chronic diseases in Enugu metropolis. Health Informatics J 2019; 26:829-840. [PMID: 31195915 DOI: 10.1177/1460458219852534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Home telemonitoring is a promising approach in the management of patients with chronic diseases. However, no study has assessed its acceptability and possible service charge in Nigeria. Therefore, this study aimed to evaluate willingness to pay for pharmacist-provided telemonitoring among patients with chronic diseases and to explore its determinants. Hence, using the contingent valuation method, a cross-sectional study was conducted among eligible patients visiting 15 selected community pharmacies in Enugu metropolis, over a period of 3 months. Of the 335 patients who participated in the study, about 40 percent (i.e. 39.4%) were willing to pay an average monthly fee of ₦915.91 ± 485.49 (US$2.99 ± 1.59) for home telemonitoring services. Significant predictors of willingness to pay for home telemonitoring were perceived insufficient income (odds ratio = 0.20, 95% confidence interval = 0.07-0.60, p = 0.040) and health insurance status (odds ratio = 0.39, 95% confidence interval = 0.18-0.86, p = 0.019). Our findings suggest a promising potential for adopting home telemonitoring services among patients with chronic diseases in Enugu metropolis.
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11
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Can telehealth reduce health care expenditure? A lesson from German health insurance data. Int J Health Plann Manage 2019; 34:1121-1132. [DOI: 10.1002/hpm.2764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/07/2022] Open
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Werhahn SM, Dathe H, Rottmann T, Franke T, Vahdat D, Hasenfuß G, Seidler T. Designing meaningful outcome parameters using mobile technology: a new mobile application for telemonitoring of patients with heart failure. ESC Heart Fail 2019; 6:516-525. [PMID: 30868756 PMCID: PMC6487706 DOI: 10.1002/ehf2.12425] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Health data captured by commercially available smart devices may represent meaningful patient‐reported outcome measures (PROMs) in heart failure (HF) patients. The purpose of this study was to test this hypothesis by evaluating the feasibility of a new telemonitoring concept for patients following initial HF hospitalization. Methods and results We designed a cardio patient monitoring platform (CPMP) that comprised mobile iOS‐based applications for patients' smartphone/smartwatch and the equivalent application on a physicians' tablet. It allowed for safe and continuous data transmission of self‐measured physiological parameters, activity data, and patient‐reported symptoms. In a prospective feasibility trial with 692 patient days from 10 patients hospitalized for newly diagnosed HF with reduced ejection fraction (mean left ventricular ejection fraction (LVEF) 26.5 ± 9.8%), we examined the CPMP during the first 2 months following discharge (69 ± 15 observation days per patient). The mean daily step count recorded by the mobile devices emerged as a promising new PROM. Its 14 day average increased over the study period (3612 ± 3311 steps/day at study inclusion and 7069 ± 5006 steps/day at end of study; P < 0.0001). It is unique for continuously reflecting real‐life activity and correlated significantly with traditional surrogate parameters of cardiac performance including LVEF (r = 0.44; 95% CI 0.07–0.71; P = 0.0232), 6 min walk test (r = 0.67; 95% CI 0.38–0.84; P = 0.0002), and scores in health‐related quality of life questionnaires. Conclusions We provide the first patient monitoring platform for HF patients that relies on commercially available iOS/watchOS‐based devices. Our study suggests it is ready for implementation as a tool for recording meaningful PROMs in future HF trials and telemonitoring.
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Affiliation(s)
- Stefanie Maria Werhahn
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,DZHK, partner site Göttingen, Göttingen, Germany
| | - Henning Dathe
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.,DZHK, partner site Göttingen, Göttingen, Germany
| | - Thorsten Rottmann
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.,DZHK, partner site Göttingen, Göttingen, Germany
| | - Thomas Franke
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.,DZHK, partner site Göttingen, Göttingen, Germany
| | | | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,DZHK, partner site Göttingen, Göttingen, Germany
| | - Tim Seidler
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,DZHK, partner site Göttingen, Göttingen, Germany
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13
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Ware P, Seto E, Ross HJ. Accounting for Complexity in Home Telemonitoring: A Need for Context-Centred Evidence. Can J Cardiol 2018; 34:897-904. [DOI: 10.1016/j.cjca.2018.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 01/17/2023] Open
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14
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Gingele AJ, Brunner-la Rocca H, Ramaekers B, Gorgels A, De Weerd G, Kragten J, van Empel V, Brandenburg V, Vrijhoef H, Cleuren G, Knackstedt C, Boyne JJ. Telemonitoring in patients with heart failure: Is there a long-term effect? J Telemed Telecare 2017; 25:158-166. [PMID: 29251245 DOI: 10.1177/1357633x17747641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Evidence suggests that telemonitoring decreases mortality and heart failure (HF)-related hospital admission in patients with HF. However, most studies follow their patients for only several months. Little is known about the long-term effects of telemonitoring after a period of application. METHODS In 2007, the TEHAF study was initiated to compare tailored telemonitoring with usual care with respect to time until first HF-related hospital admission. In total, 301 patients completed the study after a follow-up period of one year. No differences could be found in time to first HF-related admission between intervention and control groups. Here, we performed a retrospective analysis in order to investigate potential long-term effects of telemonitoring. The primary endpoint was time to first HF-related hospital admission. Secondary endpoints were, amongst others, all-cause mortality, hospital admission due to HF and days alive and out of hospital (DAOOH). Electronic files of all included patients were reviewed between October 2007 and September 2015. RESULT Mean follow-up duration was 1652 days (standard deviation: 1055 days). No significant difference in time to first HF-related hospital admission (log-rank test, p = 0.15), all-cause mortality (log-rank test, p = 0.43), or DAOOH (two-sample t-test, p = 0.87) could be found. However, patients that underwent telemonitoring had significantly fewer HF-related hospital admissions (incident rate ratio 0.54, 95% confidence interval 0.31-0.88). DISCUSSION Telemonitoring did not significantly influence the long-term outcome in our study. Therefore, extending the follow-up period of telemonitoring studies in HF patients is probably not beneficial.
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Affiliation(s)
- Arno J Gingele
- 1 Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Bram Ramaekers
- 2 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anton Gorgels
- 1 Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gerjan De Weerd
- 3 Department of Cardiology, Zuyderland Hospital, Sittard, The Netherlands
| | - Johannes Kragten
- 4 Department of Cardiology, Zuyderland Hospital, Heerlen, The Netherlands
| | - Vanessa van Empel
- 1 Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Hubertus Vrijhoef
- 6 Department of Family Medicine, Vrije Universiteit Brussels, Brussels, Belgium.,7 Panaxea BV, Amsterdam, The Netherlands
| | - Ger Cleuren
- 8 Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands.,9 CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Christian Knackstedt
- 1 Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Josiane Jj Boyne
- 8 Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands.,9 CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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15
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Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C, Hinder S, Fahy N, Procter R, Shaw S. Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 2017; 19:e367. [PMID: 29092808 PMCID: PMC5688245 DOI: 10.2196/jmir.8775] [Citation(s) in RCA: 883] [Impact Index Per Article: 126.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/08/2017] [Accepted: 09/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. OBJECTIVE Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. METHODS The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. RESULTS The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. CONCLUSIONS Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.
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Affiliation(s)
- Trisha Greenhalgh
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jennifer Lynch
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Gemma Hughes
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Christine A'Court
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan Hinder
- RAFT Research and Consulting Ltd, Clitheroe, Lancs, United Kingdom
| | - Nick Fahy
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rob Procter
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Sara Shaw
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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16
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Bloom MW, Greenberg B, Jaarsma T, Januzzi JL, Lam CSP, Maggioni AP, Trochu JN, Butler J. Heart failure with reduced ejection fraction. Nat Rev Dis Primers 2017; 3:17058. [PMID: 28836616 DOI: 10.1038/nrdp.2017.58] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heart failure is a global public health problem that affects more than 26 million people worldwide. The global burden of heart failure is growing and is expected to increase substantially with the ageing of the population. Heart failure with reduced ejection fraction accounts for approximately 50% of all cases of heart failure in the United States and is associated with substantial morbidity and reduced quality of life. Several diseases, such as myocardial infarction, certain infectious diseases and endocrine disorders, can initiate a primary pathophysiological process that can lead to reduced ventricular function and to heart failure. Initially, ventricular impairment is compensated for by the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, but chronic activation of these pathways leads to worsening cardiac function. The symptoms of heart failure can be associated with other conditions and include dyspnoea, fatigue, limitations in exercise tolerance and fluid accumulation, which can make diagnosis difficult. Management strategies include the use of pharmacological therapies and implantable devices to regulate cardiac function. Despite these available treatments, heart failure remains incurable, and patients have a poor prognosis and high mortality rate. Consequently, the development of new therapies is imperative and requires further research.
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Affiliation(s)
- Michelle W Bloom
- Division of Cardiology, Stony Brook University Medical Center, 101 Nicolls Road, HSC, T-16, Rm 080, Stony Brook, New York 11794-8167, USA
| | - Barry Greenberg
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, California, USA
| | - Tiny Jaarsma
- Faculty of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Programme in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Medical School, Singapore
| | - Aldo P Maggioni
- Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - Jean-Noël Trochu
- l'institut du thorax, Centre Hospital-Universitaire de Nantes, Nantes, France.,Medical School, University of Nantes, Nantes, France.,INSERM UMR1087 and CIC 1413, Nantes, France
| | - Javed Butler
- Division of Cardiology, Stony Brook University Medical Center, 101 Nicolls Road, HSC, T-16, Rm 080, Stony Brook, New York 11794-8167, USA
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17
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Greenhalgh T, A’Court C, Shaw S. Understanding heart failure; explaining telehealth - a hermeneutic systematic review. BMC Cardiovasc Disord 2017; 17:156. [PMID: 28615004 PMCID: PMC5471857 DOI: 10.1186/s12872-017-0594-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. METHODS Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. RESULTS Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. CONCLUSION The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Christine A’Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
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18
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Mickelson RS, Holden RJ. Mind the gulfs: An analysis of medication-related cognitive artifacts used by older adults with heart failure. ACTA ACUST UNITED AC 2016; 59:481-485. [PMID: 28674478 DOI: 10.1177/1541931215591103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Medication management is a patient health-related activity characterized by poor performance in older adults with chronic disease. Interventions focus on educating and motivating the patient with limited long-term effects. Cognitive artifacts facilitate cognitive tasks by making them easier, faster, and more effective and can potentially improve medication management performance. This study examined how older adult patients with heart failure use cognitive artifacts and how representational structure and physical properties facilitated or impeded medication-related tasks and processes. Interview, observation, medical record, and photographic data of and about older patients with heart failure (N = 30) and their informal caregivers (N=14) were content analyzed for cross-cutting themes about patient goals, representations, and actions. Results illustrated patient artifacts designed from a clinical rather than patient perspective, disparate internal and external representations threatening safety, and incomplete information exchange between patients and clinicians. Implications for design were the need for bridging artifacts, automatic information transfer, and cognitive artifacts designed from the perspective of the patient.
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Affiliation(s)
- Robin S Mickelson
- Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, USA.,The Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
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19
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Frankenstein L, Fröhlich H, Cleland JGF. Multidisciplinary Approach for Patients Hospitalized With Heart Failure. ACTA ACUST UNITED AC 2016; 68:885-91. [PMID: 26409892 DOI: 10.1016/j.rec.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/04/2015] [Indexed: 12/24/2022]
Abstract
Acute heart failure describes the rapid deterioration, over minutes, days or hours, of symptoms and signs of heart failure. Its management is an interdisciplinary challenge that requires the cooperation of various specialists. While emergency providers, (interventional) cardiologists, heart surgeons, and intensive care specialists collaborate in the initial stabilization of acute heart failure patients, the involvement of nurses, discharge managers, and general practitioners in the heart failure team may facilitate the transition from inpatient care to the outpatient setting and improve acute heart failure readmission rates. This review highlights the importance of a multidisciplinary approach to acute heart failure with particular focus on the chain-of-care delivered by the various services within the healthcare system.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom
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20
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Abstract
Patients with chronic heart failure (CHF) living in rural areas face an increased risk of adverse cardiovascular events. Even in countries with universal access to health care, rural areas are characteristically underserved, with reduced health care providers supply, greater distance to health care centers, decreased physician density with higher reliance on generalists, and high health care staff turnover. On the other hand, patient-related characteristics vary widely among published data. This review describes the epidemiology of CHF in rural or remote settings, organizational and patient-related factors involved in cardiovascular outcomes, and the role of interventions to improve rural health care.
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Affiliation(s)
- Hugo E Verdejo
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile.
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases FONDAP ACCDis, Division of Public Health and Family Medicine, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 434, CP 8330073, Santiago, Chile
| | - Pablo F Castro
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile
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21
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Gastelurrutia P, Lupón J, Domingo M, Stut W, Dovancescu S, Cleland J, Frankenstein L, Bayes-Genis A. Potential role for clinical calibration to increase engagement with and application of home telemonitoring: a report from the HeartCycle programme. ESC Heart Fail 2016; 4:66-70. [PMID: 28217314 PMCID: PMC5292630 DOI: 10.1002/ehf2.12104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 12/18/2022] Open
Abstract
Aims There is a need for alternative strategies that might avoid recurrent admissions in patients with heart failure. home telemonitoring (HTM) to monitor patient's symptoms from a distance may be useful. This study attempts to assess changes in HTM vital signs in response to daily life activities (variations in medication, salt intake, exercise, and stress) and to establish which variations affect weight, blood pressure, and heart rate. Methods and results We assessed 76 patients with heart failure (mean age 76 ± 10.8 years, 75% male, mainly in NYHA class II/III and from ischaemic aetiology cause). Patients were given a calendar of interventions scheduling activities approximately twice a week before measuring their vital signs. Eating salty food or a large meal were the activities that had a significant impact on weight gain (+0.3 kg; P < 0.001 and P = 0.006, respectively). Exercise and skipping a dose of medication other than diuretics increased heart rate (+3 bpm, P = 0.001 and almost +2 bpm, P = 0.016, respectively). Conclusions Our HTM system was able to detect small changes in vital signs related to these activities. Further studies should assess if providing such a schedule of activities might be useful for patient education and could improve long‐term adherence to recommended lifestyle changes.
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Affiliation(s)
- Paloma Gastelurrutia
- ICREC Research Program Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP) Badalona Spain
| | - Josep Lupón
- Cardiology ServiceHospital Universitari Germans Trias i PujolBadalonaSpain; Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Mar Domingo
- Cardiology Service Hospital Universitari Germans Trias i Pujol Badalona Spain
| | - Wim Stut
- Philips Research Eindhoven The Netherlands
| | | | - John Cleland
- National Heart and Lung Institute Harefield Hospital, Imperial College London UK
| | | | - Antoni Bayes-Genis
- ICREC Research ProgramFundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP)BadalonaSpain; Cardiology ServiceHospital Universitari Germans Trias i PujolBadalonaSpain; Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
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22
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Hindricks G, Varma N. Remote monitoring and heart failure: monitoring parameters, technology, and workflow. Eur Heart J 2016; 37:3164-3166. [DOI: 10.1093/eurheartj/ehw201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Mickelson RS, Willis M, Holden RJ. Medication-related cognitive artifacts used by older adults with heart failure. HEALTH POLICY AND TECHNOLOGY 2015; 4:387-398. [PMID: 26855882 PMCID: PMC4741110 DOI: 10.1016/j.hlpt.2015.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To use a human factors perspective to examine how older adult patients with heart failure use cognitive artifacts for medication management. METHODS We performed a secondary analysis of data collected from 30 patients and 14 informal caregivers enrolled in a larger study of heart failure self-care. Data included photographs, observation notes, interviews, video recordings, medical record data, and surveys. These data were analyzed using an iterative content analysis. RESULTS Findings revealed that medication management was complex, inseparable from other patient activities, distributed across people, time, and place, and complicated by knowledge gaps. We identified fifteen types of cognitive artifacts including medical devices, pillboxes, medication lists, and electronic personal health records used for: 1) measurement/evaluation; 2) tracking/communication; 3) organization/administration; and 4) information/sensemaking. These artifacts were characterized by fit and misfit with the patient's sociotechnical system and demonstrated both advantages and disadvantages. We found that patients often modified or "finished the design" of existing artifacts and relied on "assemblages" of artifacts, routines, and actors to accomplish their self-care goals. CONCLUSIONS Cognitive artifacts are useful but sometimes are poorly designed or are not used optimally. If appropriately designed for usability and acceptance, paper-based and computer-based information technologies can improve medication management for individuals living with chronic illness. These technologies can be designed for use by patients, caregivers, and clinicians; should support collaboration and communication between these individuals; can be coupled with home-based and wearable sensor technology; and must fit their users' needs, limitations, abilities, tasks, routines, and contexts of use.
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Affiliation(s)
- Robin S. Mickelson
- Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, USA
- The Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matt Willis
- School of Information Studies, Syracuse University, Syracuse, NY, USA
| | - Richard J. Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
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24
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Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, Jaarsma T. Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey. J Med Internet Res 2015; 17:e258. [PMID: 26567061 PMCID: PMC4704966 DOI: 10.2196/jmir.4825] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/19/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
Background Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries. Objective We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden. Methods This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring. Results The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6%, 82/378; in Sweden: 30.0%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1%, 352/374) and Sweden (88.7%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9%, 100/115) and to do remote drug titration (79.1%, 91/115). Just under a quarter of Japanese (22.4%, 85/378) and over a third of Swedish (38.1%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers “how are we going to do it?” (categories include structure and resource), health care professionals themselves “what do we need to know and do” (reservation), and barriers related to patients “not everybody would benefit” (internal and external shortcomings). Conclusions Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients’ hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring.
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Affiliation(s)
- Naoko P Kato
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.
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25
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Hendriks JML, Walfridsson U, Johansson P, Strömberg A. E-health in patients with atrial fibrillation. Eur J Cardiovasc Nurs 2015; 15:200-2. [DOI: 10.1177/1474515115616723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jeroen ML Hendriks
- Department of Health and Medical Sciences, Linköping University, Linköping, Sweden
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, The University of Adelaide, Adelaide, Australia
| | - Ulla Walfridsson
- Department of Health and Medical Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health and Medical Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health and Medical Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
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26
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Pellicori P, Kaur K, Clark AL. Fluid Management in Patients with Chronic Heart Failure. Card Fail Rev 2015; 1:90-95. [PMID: 28785439 PMCID: PMC5490880 DOI: 10.15420/cfr.2015.1.2.90] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Congestion, or fluid overload, is a classic clinical feature of patients presenting with heart failure patients, and its presence is associated with adverse outcome. However, congestion is not always clinically evident, and more objective measures of congestion than simple clinical examination may be helpful. Although diuretics are the mainstay of treatment for congestion, no randomised trials have shown the effects of diuretics on mortality in chronic heart failure patients. Furthermore, appropriate titration of diuretics in this population is unclear. Research is required to determine whether a robust method of detecting - and then treating - subclinical congestion improves outcomes.
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Affiliation(s)
- Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Kuldeep Kaur
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
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