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Liu JC, Cheng CY, Cheng TH, Liu CN, Chen JJ, Hao WR. Unveiling the Potential: Remote Monitoring and Telemedicine in Shaping the Future of Heart Failure Management. Life (Basel) 2024; 14:936. [PMID: 39202678 PMCID: PMC11355081 DOI: 10.3390/life14080936] [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: 06/20/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 09/03/2024] Open
Abstract
Heart failure (HF) remains a significant burden on global healthcare systems, necessitating innovative approaches for its management. This manuscript critically evaluates the role of remote monitoring and telemedicine in revolutionizing HF care delivery. Drawing upon a synthesis of current literature and clinical practices, it delineates the pivotal benefits, challenges, and personalized strategies associated with these technologies in HF management. The analysis highlights the potential of remote monitoring and telemedicine in facilitating timely interventions, enhancing patient engagement, and optimizing treatment adherence, thereby ameliorating clinical outcomes. However, technical intricacies, regulatory frameworks, and socioeconomic factors pose formidable hurdles to widespread adoption. The manuscript emphasizes the imperative of tailored interventions, leveraging advancements in artificial intelligence and machine learning, to address individual patient needs effectively. Looking forward, sustained innovation, interdisciplinary collaboration, and strategic investment are advocated to realize the transformative potential of remote monitoring and telemedicine in HF management, thereby advancing patient-centric care paradigms and optimizing healthcare resource allocation.
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Affiliation(s)
- Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Ministry of Health and Welfare, Taipei Medical University, New Taipei City 23561, Taiwan;
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11002, Taiwan
| | - Chun-Yao Cheng
- Department of Medical Education, National Taiwan University Hospital, Taipei 100225, Taiwan;
| | - Tzu-Hurng Cheng
- Department of Biochemistry, School of Medicine, College of Medicine, China Medical University, Taichung City 404333, Taiwan;
| | - Chen-Ning Liu
- Center of Integrated, Shuang Ho Hospital, Ministry of Health and Welfare, Taipei Medical University, New Taipei City 23561, Taiwan;
| | - Jin-Jer Chen
- Division of Cardiology, Department of Internal Medicine and Graduate Institute of Clinical Medical Science, China Medical University, Taichung 115201, Taiwan;
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Wen-Rui Hao
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Ministry of Health and Welfare, Taipei Medical University, New Taipei City 23561, Taiwan;
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11002, Taiwan
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Bernocchi P, Giudici V, Borghi G, Bertolaia P, D'Isa S, Trevisan R, Scalvini S. Telemedicine home-based management in patients with chronic heart failure and diabetes type II: study protocol for a randomized controlled trial. Trials 2024; 25:333. [PMID: 38773662 PMCID: PMC11106884 DOI: 10.1186/s13063-024-08171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Heart failure and type 2 diabetes are prevalent public health issues in Europe. These complex chronic conditions require extensive pharmacological management, ongoing self-care, and behavioral changes. Despite the known benefits of lifestyle changes, such as regular exercise and better control of blood sugar levels, patients may need help implementing the recommended changes. This study aims to assess the effectiveness of a telemedicine program for managing heart failure and type 2 diabetes at home. The program focuses on promoting lifestyle changes. METHODS AND ANALYSIS During scheduled outpatient cardiology evaluations, eligible patients are recruited and randomly assigned to either an intervention or control group in a 1:1 ratio. The intervention group receives support from a nursing case manager through a structured home-based teleassistance program and a trainer for daily physical activity stimulation. They also have access to teleconsultations with cardiologists and diabetes specialists as needed, telemonitoring of vital signs, and daily step tracking. An app records and monitors daily drug treatment, glycemia, blood pressure, heart rate, and other clinical parameters. Patients can also self-report symptoms and communicate via a chat and videoconference system with a Nurse Case Manager. The control group receives routine care. Data collection occurs before intervention and 6 months after baseline during a new outpatient cardiology evaluation. The primary outcome is to measure the difference in the distance walked during a 6-min walk test between baseline and after 6 months. The key secondary outcomes include improving the disease status and physical activity profile. Data will be analyzed according to the intention-to-treat principles. DISCUSSION This study will provide evidence on the efficacy of a telemedicine home-based management model to maintain correct lifestyles in patients with both heart failure and type 2 diabetes, improving self-management, their empowerment on the diseases, and increasing their knowledge and ability to recognize symptoms early. TRIAL REGISTRATION ClinicalTrials.gov NCT05633784. Registered on November 30, 2022.
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Affiliation(s)
- Palmira Bernocchi
- Continuity of Care Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Via G. Mazzini 129, 25065, Lumezzane, Brescia, Italy.
| | - Vittorio Giudici
- Department of Cardiac Rehabilitation, Bolognini Hospital, Azienda Socio-Sanitaria Territoriale Bergamo Est, Seriate, Bergamo, Italy
| | - Gabriella Borghi
- Continuity of Care Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Via G. Mazzini 129, 25065, Lumezzane, Brescia, Italy
| | - Patrizia Bertolaia
- Socio-Health Management Direction, Azienda Socio-Sanitaria Territoriale Bergamo Est, Seriate, Bergamo, Italy
| | - Salvatore D'Isa
- Cardiovascular Department, Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Trevisan
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Simonetta Scalvini
- Continuity of Care Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Via G. Mazzini 129, 25065, Lumezzane, Brescia, Italy
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
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Magaña Serrano JA, Cigarroa López JA, Chávez Mendoza A, Ivey-Miranda JB, Mendoza Zavala GH, Olmos Domínguez L, Chávez Leal SA, Pombo Bartelt JE, Herrera-Garza EH, Mercado Leal G, Parra Michel R, Aguilera Mora LF, Nuriulu Escobar PL. Vulnerable period in heart failure: a window of opportunity for the optimization of treatment - a statement by Mexican experts. Drugs Context 2024; 13:2023-8-1. [PMID: 38264402 PMCID: PMC10803129 DOI: 10.7573/dic.2023-8-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Acute heart failure (HF) is associated with poor prognosis. After the acute event, there is a vulnerable period during which the patient has a marked risk of readmission or death. Therefore, early optimization of treatment is mandatory during the vulnerable period. The objective of this article is to provide recommendations to address the management of patients with HF during the vulnerable period from a practical point of view. A group of Mexican experts met to prepare a consensus document. The vulnerable period, with a duration of up to 6 months after the acute event - either hospitalization, visit to the emergency department or the outpatient clinic/day hospital - represents a real window of opportunity to improve outcomes for these patients. To best individualize the recommendations, the management strategies were divided into three periods (early, intermediate and late vulnerable period), including not only therapeutic options but also evaluation and education. Importantly, the recommendations are addressed to the entire cardiology team, including physicians and nurses, but also other specialists implicated in the management of these patients. In conclusion, this document represents an opportunity to improve the management of this population at high risk, with the aim of reducing the burden of HF.
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Affiliation(s)
- José Antonio Magaña Serrano
- División de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Angel Cigarroa López
- Clínica de Insuficiencia Cardiaca Avanzada y Trasplantes de la UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS (Instituto Mexicano del Seguro Social), Ciudad de México, México
| | - Adolfo Chávez Mendoza
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Juan Betuel Ivey-Miranda
- Clínica de Insuficiencia Cardiaca Avanzada y Trasplantes de la UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS (Instituto Mexicano del Seguro Social), Ciudad de México, México
| | - Genaro Hiram Mendoza Zavala
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Luis Olmos Domínguez
- Clínica de Insuficiencia Cardiaca y Hospital de Día, Hospital de Cardiología, Centro Médico Nacional SXXI, IMSS (Instituto Mexicano del Seguro Social), Instituto Nacional de Salud Pública, Ciudad de México, México
| | | | | | - Eduardo Heberto Herrera-Garza
- Programa de Trasplante Cardiaco y Clínica de Insuficiencia Cardíaca, Hospital Christus Muguerza Alta Especialidad, Monterrey, México
| | - Gerardo Mercado Leal
- División de Cardiocirugía, Clínica de Insuficiencia Cardiaca, Trasplante Cardiaco y Hospital de Día, CMN 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Rodolfo Parra Michel
- Unidad de Coronaria y Clínica de Insuficiencia Cardíaca Avanzada e Hipertensión Arterial Pulmonar. Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Luisa Fernanda Aguilera Mora
- Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Centro Médico Puerta de Hierro, Zapopan, México
| | - Patricia Lenny Nuriulu Escobar
- Unidad de Insuficiencia Cardiaca y Cardio-Oncología del Instituto Cardiovascular de Hidalgo, Pachuca de Soto Hidalgo, Fellow SIAC, Pachuca de Soto, México
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Camino Ortega E, Baroja Gil de Gómez A, González Gamarra A, Cuevas-Budhart MA, García Klepzig JL, Gómez Del Pulgar García-Madrid M. [Education interventions in heart failure using m-Health: Systematic review]. Aten Primaria 2023; 55:102734. [PMID: 37639948 PMCID: PMC10470284 DOI: 10.1016/j.aprim.2023.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To provide the best scientific evidence available on the effectiveness of therapeutic education programs through digital health in patients with heart failure. DESIGN Systematic review of randomized clinical trials. DATA SOURCES Six databases were included due to their relevance in Health Sciences: PubMed, EMBASE, Scielo, Cochrane, CINAHL, and Web of Science. SELECTION OF STUDIES In English and Spanish, studies carried out between 2018 and 2023 were selected. After evaluating the methodological quality of the studies, the Jadad tool was used to discriminate those that did not meet said quality. In total, 8 articles from 6 different countries were included. DATA EXTRACTION The review and analysis of the documents were carried out by independent pairs. The Cochrane tool for RoB 2 randomized clinical trials was used to assess the risk of bias. RESULTS All the applications had therapeutic education, it was also assessed that they had monitoring, evaluation of signs and symptoms, drug titration, and professional follow-up through the application. CONCLUSION This review reveals the significant impact of therapeutic education in increasing patient knowledge, reducing hospital readmissions, and improving functional status and self-care. This makes digital health a valuable tool to complement nursing care in patients with heart failure.
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Affiliation(s)
- Emma Camino Ortega
- Centro de Salud Goya, Servicio Madrileño de Salud (SERMAS), Madrid, España
| | | | | | - Miguel Angel Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Severino P, Prosperi S, D'Amato A, Cestiè C, Myftari V, Maestrini V, Birtolo LI, Filomena D, Mariani MV, Lavalle C, Badagliacca R, Mancone M, Fedele F, Vizza CD. Telemedicine: an Effective and Low-Cost Lesson From the COVID-19 Pandemic for the Management of Heart Failure Patients. Curr Heart Fail Rep 2023; 20:382-389. [PMID: 37665424 PMCID: PMC10589137 DOI: 10.1007/s11897-023-00624-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this review is to explore the benefits and controversies that telemedicine (TM), applied to patients with heart failure (HF), can provide in terms of diagnosis, therapeutic management, and prognosis improvement. During the coronavirus disease 19 (COVID-19) outbreak, TM emerged as the most effective and feasible method available to ensure continuous care for chronic diseases. Among these, HF, characterized by high mortality, morbidity, and the need for frequent visits, may benefit of the TM role. HF patients are affected by frequent exacerbations undergoing a progressive prognosis impoverishment, strongly depending on the disease's management. A precise clinical handling is always required, with a constant optimization of the therapy, a continuous control of risk factors, and a sensitive attention to any change in symptoms, clinical signs, and laboratory tests. In this context, TM has shown to improve therapy adherence and HF: patients' self-care, impacting the prognosis even if specific results are controversial. Major evidence shows that TM may allow an adequate primary prevention, reducing the impact of the main cardiovascular risk factors. TM can also be useful for the secondary prevention, early detecting a likely HF exacerbation before it becomes clinically manifest, thereby lowering the need for hospitalization. Moreover, an optimal up-titration of the therapy and an increase in treatment adherence are feasible by using TM. However, some studies did not show unambiguous results, and uncertainties still remain.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Andrea D'Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
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Tozzo P, Delicati A, Marcante B, Catelan D, Caenazzo L. Lessons Learned from the COVID-19 Pandemic: A Survey-Based Study on a Sample of Italian Physicians' Opinions on Telemedicine. J Pers Med 2023; 13:1267. [PMID: 37623517 PMCID: PMC10455507 DOI: 10.3390/jpm13081267] [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: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Telemedicine was born out of the need to ensure clinical evaluation and personal care regardless of the physical presence of the healthcare professional nearby. Information technologies have been vital during the COVID-19 pandemic to ensure medical care and avoid the contagion between patients and clinicians. Accordingly, telecare services multiplied worldwide and gained paramount importance. The present work aims to collect field-based opinions about Telemedicine and ethics among Italian physicians. We developed a web-based questionnaire that was administered to Italian physicians from 1 May to 15 June 2022. The questionnaire was distributed as a link to Google Forms via social networks/instant messaging applications to groups of graduated and qualified physicians. A total of 180 physicians answered the questionnaire (with an age range from 25 to 68 years old). Physicians belonging to the medical area of expertise appear to more frequently use new technologies in comparison to other specialties. The vast majority believe that it is appropriate to use Telemedicine for monitoring and follow-up but not for evaluating a new patient. Concerns about changes in the physician-patient relationship, informed consent, digital barrier, and privacy and data protection also emerged. Finally, telehealth is thought to be a potential useful tool for the future by the majority of respondents but proper training for physicians is therefore needed.
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Affiliation(s)
- Pamela Tozzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
| | - Arianna Delicati
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
| | - Beatrice Marcante
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
| | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
| | - Luciana Caenazzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
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Gori M, Bonmassari R, Correale M, Franzini J, Iacoviello M, Dico GL, Moretti M, Navazio A, Pellegrini L, Volpe M, Senni M. LEAP Virtual Visit Assessment (VIVA): a structured protocol for virtual visits for patients with heart failure. J Cardiovasc Med (Hagerstown) 2022; 23:685-690. [PMID: 36099076 DOI: 10.2459/jcm.0000000000001350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Telemedicine may be of benefit in patients with heart failure (HF), although virtual visits are often carried out on an ad hoc basis. Herein, we discuss a structured protocol that defines all the steps needed for virtual visits, LEAP Virtual Visit, which includes guides and support kits for clinicians and patients. METHODS A working group of clinicians was established to develop a protocol for virtual visits. The virtual model for monitoring HF patients was based on measurement and sizing of patient flows, type of services, and critical organizational points. The process of virtual visits was broken down to identify the specific activities, players, roles, and support tools needed for implementation in daily practice. RESULTS In the protocol developed, sections were included on patient eligibility, exams, supportive tools, and practical organizational aspects. IT requirements were also considered and the most widely used teleconference platforms were compared according to features that were considered to be priority for virtual visits. Protocols and support kits were developed, including guides for clinicians and patients, two questionnaires to assess the level of satisfaction, patient diary, disease awareness brochure, and template to monitor key performance indicators. The phases include an enrolment phase, document sharing phase, pre-evaluation phase, the virtual visit itself, and the post-visit phase. The protocol for the virtual visit was divided into 8 sequential steps to be carried out between the clinic and patient/caregiver. CONCLUSION The protocol described can be expected to have a number of benefits for the patient, clinic, and healthcare structure.
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Affiliation(s)
- Mauro Gori
- Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo, Bergamo
| | | | - Michele Correale
- Department of Cardiology, Policlinico Riuniti University Hospital, Foggia
| | | | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Foggia
| | | | | | - Alessandro Navazio
- Cardiology Division, Presidio Ospedaliero ASMN Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | | | | | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo, Bergamo
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8
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Thomas SC. Telehealth in heart failure care: Does it work? Heart Lung 2022; 55:A1. [PMID: 35641336 DOI: 10.1016/j.hrtlng.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ghilencea LN, Chiru MR, Stolcova M, Spiridon G, Manea LM, Stănescu AMA, Bokhari A, Kilic ID, Secco GG, Foin N, Di Mario C. Telemedicine: Benefits for Cardiovascular Patients in the COVID-19 Era. Front Cardiovasc Med 2022; 9:868635. [PMID: 35935629 PMCID: PMC9347362 DOI: 10.3389/fcvm.2022.868635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
The recent pandemic with SARS-CoV-2 raises questions worldwide regarding telemedicine for housebound patients, including those with cardiovascular conditions. The need for further investigation, monitoring and therapeutic management are advancing practical issues which had not been identified for consideration prior to the pandemic. Using the marketing assessment, we identified the needs of the patients and evaluated the future steps necessary in the short term to meet them. The research found progress made via telemedicine in monitoring and conducting minor decisions (like up-titrating the doses of different medication regimens) in patients with several cardiovascular diseases (heart failure, atrial fibrillation, high blood pressure), as there is a worldwide trend to develop new telemonitoring biosensors and devices based on implantable delivered transcatheter. The worldwide telemedicine trend encourages a switch from small and hesitating steps to a more consistent assessment of the patients, based on high technology and Interventional Cardiology. Cardiovascular telemedicine, although made a sustainable effort in managing patients' health, has many obstacles to overcome before meeting all their needs. Data security, confidentiality and reimbursement are the top priorities in developing remote Cardiology. The regulatory institutions need to play an integrative role in leading the way for defining the framework of future telemedicine activities. The SARS-CoV-2 outbreak with all its tragedy served to reinforce the message that telemedicine services can be life-saving for cardiovascular patients. Once the Covid-19 era will fade away, telemedicine is likely to remain a complementary service of standard care. There is still room to improve the remote identification and investigation of heart disease, provide an accurate diagnosis and therapeutic regimen, and update regulations and guidelines to the new realities of technological progress in the field.
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Affiliation(s)
- Liviu-Nicolae Ghilencea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Miroslava Stolcova
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Gabriel Spiridon
- Department and European Project Development, Institute of Scientific Research and Technological Development in Automation and Informatics, Bucharest, Romania
| | - Laura-Maria Manea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Awais Bokhari
- Department of Cardiology, Bedford Hospital NHS Foundation Trust, Bedford, United Kingdom
| | - Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University Hospital, Denizli, Turkey
| | - Gioel Gabriel Secco
- Department of Interventional Cardiology and Structural Heart Disease, SS. Antonio e Biagioe Cesare Arrigo Hospital, Alessandria, Italy
| | - Nicolas Foin
- Duke-NUS Medical School, National Heart Research Institute, Singapore, Singapore
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
- Royal Brompton Hospital, NHSFT, London, United Kingdom
- Department of Cardiology, University of Florence, Florence, Italy
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Binci D, Palozzi G, Scafarto F. Toward digital transformation in healthcare: a framework for remote monitoring adoption. TQM JOURNAL 2021. [DOI: 10.1108/tqm-04-2021-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PurposeDigital transformation (DT) is a priority for the healthcare sector. In many countries, it is still considered in the early stages with an underestimation of its benefits and potentiality. Especially in Italy, little is known about the impact of digitalization – particularly of the Internet of Things (IoT) – on the healthcare sector, for example, in terms of clinician's jobs and patient's experience. Drawing from such premises, the paper aims to focus on an overlooked healthcare area related to the chronic heart diseases field and its relationship with DT. The authors aim at exploring and framing the main variables of remote Monitoring (RM) adoption as a specific archetype of healthcare digitalization, both on patients and medical staff level, by shedding some lights on its overall implementation.Design/methodology/approachThe authors empirically inquiry the RM adoption within the context of the Cardiology Department of the Casilino General Hospital of Rome. To answer our research question, the authors reconstruct the salient information by using induction-type reasoning, direct observation and interviewees with 12 key informants, as well as secondary sources analysis related to the hospital (internal documentation, presentations and technical reports).FindingsAccording to a socio-technical framework, the authors build a model composed of five main variables related to medical staff and patients. The authors classify such variables into an input-process-output (I-P-O) model. RM adoption driver represents the input; cultural digital divide, structure flexibility and reaction to change serve the process and finally, RM outcome stands for the output. All these factors, interacting together, contribute to understanding the RM adoption process for chronic disease management.Research limitations/implicationsThe authors' research presents two main limitations. The first one is related to using a qualitative method, which is less reliable in terms of replication and the interpretive role of researchers. The second limitation, connected to the first one, is related to the study's scale level, which focuses on a mono-centric consistent level of analysis.Practical implicationsThe paper offers a clear understanding of the RM attributes and a comprehensive view for improving the overall quality management of chronic diseases by suggesting that clinicians carefully evaluate both hard and soft variables when undertaking RM adoption decisions.Social implicationsRM technologies could impact on society both in ordinary situations, by preventing patient mobility issues and transport costs, and in extraordinary times (such as a pandemic), where telemedicine contributes to supporting hospitals in swapping in-person visits with remote controls, in order to minimize the risk of coronavirus disease (COVID-19) contagion or the spread of the virus.Originality/valueThe study enriches the knowledge and understanding of RM adoption within the healthcare sector. From a theoretical perspective, the authors contribute to the healthcare DT adoption debate by focusing on the main variables contributing to the DT process by considering both medical staff and patient's role. From a managerial perspective, the authors highlight the main issues for RM of chronic disease management to enable the transition toward its adoption. Such issues range from the need for awareness of the medical staff about RM advantages to the need for adapting the organizational structure and the training and education process of the patients.
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11
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Ansari Ramandi MM, Yarmohammari H, Naderi N. A call for telehealth application for heart failure patients during the Coronavirus 2019 pandemic. ESC Heart Fail 2021; 8:3431-3432. [PMID: 33934547 PMCID: PMC8239573 DOI: 10.1002/ehf2.13387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/14/2020] [Accepted: 04/12/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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12
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Silva-Cardoso J, Juanatey JRG, Comin-Colet J, Sousa JM, Cavalheiro A, Moreira E. The Future of Telemedicine in the Management of Heart Failure Patients. Card Fail Rev 2021; 7:e11. [PMID: 34136277 PMCID: PMC8201465 DOI: 10.15420/cfr.2020.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Telemedicine (TM) is potentially a way of escalating heart failure (HF) multidisciplinary integrated care. Despite the initial efforts to implement TM in HF management, we are still at an early stage of its implementation. The coronavirus disease 2019 pandemic led to an increased utilisation of TM. This tendency will probably remain after the resolution of this threat. Face-to-face medical interventions are gradually transitioning to the virtual setting by using TM. TM can improve healthcare accessibility and overcome geographic inequalities. It promotes healthcare system efficiency gains, and improves patient self-management and empowerment. In cooperation with human intervention, artificial intelligence can enhance TM by helping to deal with the complexities of multicomorbidity management in HF, and will play a relevant role towards a personalised HF patient approach. Artificial intelligence-powered/telemedical/heart team/multidisciplinary integrated care may be the next step of HF management. In this review, the authors analyse TM trends in the management of HF patients and foresee its future challenges within the scope of HF multidisciplinary integrated care.
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Affiliation(s)
- José Silva-Cardoso
- Faculty of Medicine, University of PortoPorto, Portugal
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | | | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de LlobregatBarcelona, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L’Hospitalet de LlobregatBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - José Maria Sousa
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | - Ana Cavalheiro
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
- Department of Physical Rehabilitation, Centro Hospitalar do PortoPorto, Portugal
| | - Emília Moreira
- Faculty of Medicine, University of PortoPorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
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Pagliani L, Elisa N, Eduardo RD, Lorenza DC, Agnese DN, Antonini-Canterin F. Role of New Technologies in Supporting the Treatment of Complex Patients. Heart Fail Clin 2021; 17:279-287. [PMID: 33673952 DOI: 10.1016/j.hfc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiology represents one of the privileged disciplinary areas for the experimentation and validation of the applications of telemedicine. Telemedicine, and the health technologies that go by the name of eHealth, identify the digital exchange of social and health information in order to support and optimize the care process remotely. Telemonitoring applied to cardiovascular diseases is defined as the recording, remote transmission, storage, and interpretation of cardiovascular parameters and diagnostic images. Meta-analyses have shown that telemedicine-supported models of care not only are effective but also cost-effective.
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Affiliation(s)
- Leopoldo Pagliani
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy.
| | - Nicolosi Elisa
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Rivaben Dante Eduardo
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Dal Corso Lorenza
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Di Naro Agnese
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
| | - Francesco Antonini-Canterin
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Via Padre Bello 3c, Motta di Livenza, Treviso 31045, Italy
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14
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Singh A, Mountjoy N, McElroy D, Mittal S, Al Hemyari B, Coffey N, Miller K, Gaines K. Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study. JMIR Cardio 2021; 5:e25074. [PMID: 33385234 PMCID: PMC7834614 DOI: 10.2196/25074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/23/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits.
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Affiliation(s)
- Aniruddha Singh
- Western Kentucky Heart and Lung Research Foundation, Bowling Green, KY, United States
| | | | - Doug McElroy
- Western Kentucky University, Bowling Green, KY, United States
| | - Shilpi Mittal
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bashar Al Hemyari
- University of Kentucky College of Medicine, Bowling Green, KY, United States
| | - Nicholas Coffey
- University of Kentucky College of Medicine, Bowling Green, KY, United States
| | - Kristen Miller
- University of Kentucky College of Medicine, Bowling Green, KY, United States
| | - Kenneth Gaines
- Vanderbilt University Medical Center, Nashville, TN, United States
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15
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Monje MHG, Fuller RLM, Cubo E, Mestre TA, Tan AH, Stout JC, Ali S, Chahine L, Dujardin K, Fitzer-Attas CJ, Youn J, Bloem BR, Horak FB, Merola A, Reilmann R, Paul SS, Dorsey ER, Maetzler W, Espay AJ, Martinez-Martin P, Stebbins GT, Sánchez-Ferro Á. Toward e-Scales: Digital Administration of the International Parkinson and Movement Disorder Society Rating Scales. Mov Disord Clin Pract 2020; 8:208-214. [PMID: 33553489 DOI: 10.1002/mdc3.13135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/30/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur Madrid Spain.,Department of Anatomy, Histology and Neuroscience, School of Medicine Universidad Autónoma de Madrid Madrid Spain
| | | | - Esther Cubo
- Neurology Department Hospital Universitario Burgos Burgos Spain
| | - Tiago A Mestre
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine The Ottawa Hospital Research Institute, University of Ottawa Ottawa Ontario Canada
| | - Ai Huey Tan
- Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Shazia Ali
- International Movement Disorders Society Milwaukee Illinois USA
| | - Lana Chahine
- Neurology Department, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Kathy Dujardin
- Movement Disorders Department Lille University Medical Center Lille France
| | | | - Jinyoung Youn
- Neurology Department Samsung Medical Center School of Medicine Seoul South Korea
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology Centre of Expertise for Parkinson & Movement Disorders Nijmegen The Netherlands
| | - Fay B Horak
- Department of Neurology Oregon Health and Science University Portland Oregon USA
| | - Aristide Merola
- Department of Neurology Ohio State Wexner Medical Center Columbus Ohio USA
| | - Ralf Reilmann
- George-Huntingon-Institute & Department of Clinical Radiology University of Muenster Münster Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research University of Tuebingen Tübingen Germany
| | - Serene S Paul
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Earl Ray Dorsey
- Center for Health + Technology and Department of Neurology University of Rochester Medical Center Rochester New York USA
| | - Walter Maetzler
- Department of Neurology University Hospital Schleswig-Holstein, Kiel University Kiel Germany
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders and Neurology Department University of Cincinnati Cincinnati Ohio USA
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED) Carlos III Institute of Health Madrid Spain
| | - Glenn T Stebbins
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
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16
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Kowalska M, Gładyś A, Kalańska-Łukasik B, Gruz-Kwapisz M, Wojakowski W, Jadczyk T. Readiness for Voice Technology in Patients With Cardiovascular Diseases: Cross-Sectional Study. J Med Internet Res 2020; 22:e20456. [PMID: 33331824 PMCID: PMC7775197 DOI: 10.2196/20456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/21/2020] [Accepted: 09/17/2020] [Indexed: 01/19/2023] Open
Abstract
Background The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients’ readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD). Objective This paper aims to evaluate patients’ anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone. Methods A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology. Results In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively). Conclusions Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.
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Affiliation(s)
- Małgorzata Kowalska
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Gładyś
- Student Scientific Society, Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Barbara Kalańska-Łukasik
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Monika Gruz-Kwapisz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Jadczyk
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.,Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,Research and Development Division, CardioCube Corp, Seattle, WA, United States
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17
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Mortara A, Margonato D. Proactive management of heart failure by digital health: is monitoring of invasive pulmonary artery pressure the
Holy Grail
? Eur J Heart Fail 2020; 22:1920-1922. [DOI: 10.1002/ejhf.1966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Andrea Mortara
- Heart Failure Unit and Department of Cardiology Policlinico di Monza Monza Italy
| | - Davide Margonato
- Heart Failure Unit and Department of Cardiology Policlinico di Monza Monza Italy
- Department of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
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18
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Ajibade A, Younas H, Pullan M, Harky A. Telemedicine in cardiovascular surgery during COVID-19 pandemic: A systematic review and our experience. J Card Surg 2020; 35:2773-2784. [PMID: 32881081 PMCID: PMC7460963 DOI: 10.1111/jocs.14933] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective The SAR‐COV‐2 pandemic has had an unprecedented effect on the UK's healthcare systems. To reduce spread of the virus, elective treatments and surgeries have been postponed or canceled. There has been a rise in the use of telemedicine (TM) as an alternative way to carry outpatient consultations. This systematic review aims to evaluate the extent to which TM may be able to support cardiac and vascular surgery patients in the COVID‐19 era. Methods We looked into how TM can support the management of patients via triaging, preoperative, and postoperative care. Evaluations targeted the clinical effectiveness of common TM methods and the feasibility of applying those methods in the UK during this pandemic. Results Several studies have published their evidence on the benefit of TM and its benefit during COVID‐19, the data related to cardiovascular surgery and how this will impact future practice of this speciality is emerging and yet larger studies with appropriate timing of outcomes to be published. Conclusion Overall, the use of virtual consultations and remote monitoring is feasible and best placed to support these patients via triaging and postoperative monitoring. However, TM can be limited by the need of sophisticated technological requirement and patients’ educational and know‐how computer literacy level.
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Affiliation(s)
- Ayomikun Ajibade
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Hiba Younas
- St George's Medical School, University of London, London, UK
| | - Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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De Simone V, Guarise P, Guardalben S, Padovani N, Tondelli S, Sandrini D, Visentin E, Zanotto G. Telecardiology during the Covid-19 pandemic: past mistakes and future hopes. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:34-47. [PMID: 32685262 PMCID: PMC7364274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Covid-19 has caused a striking global impact on public health services. The inevitable suspension of all scheduled visits without urgency and non-urgent hospitalizations has resulted in relevant modifications in our management of cardiac patients. Our goal should be to maintain high standards in the treatment of cardiovascular diseases, reducing the risk of esposure to Covid-19 for patients and healthcare professionals. Our Division of Cardiology follows 300 patients in a Heart Failure Ambulatory and almost all of these, as CIEDs' carriers, are monitored by remote monitoring; in addition, we follow more than 2000 CIEDs' carriers using remote monitoring. The purpose of telemedicine, using telecommunications technology, must be to optimize the clinical management of heart failure patients at home, in order to improve their quality of life, reducing hospitalization and emergency department access, also promoting self-management. The evolution of technology has led to the development and refinement of telemedicine and remote monitoring and even more in pandemic times these methods are to be considered a cornerstone. So that telemedicine can really become a well-structured reality, the following are fundamental: the uniform recognition of a reimbursement for this type of medical service, the creation of an organizational model with an adequately structured team, a valid integration with the territorial reality.
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Affiliation(s)
| | - Paola Guarise
- Department of Cardiology, Mater Salutis Hospital Legnago (VR), Italy
| | | | - Nicola Padovani
- Department of Cardiology, Mater Salutis Hospital Legnago (VR), Italy
| | - Silvia Tondelli
- Department of Cardiology, Mater Salutis Hospital Legnago (VR), Italy
| | - Davide Sandrini
- Department of Cardiology, Mater Salutis Hospital Legnago (VR), Italy
| | - Emanuela Visentin
- Department of Cardiology, Mater Salutis Hospital Legnago (VR), Italy
| | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital Legnago (VR), Italy
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20
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State and trait anxiety in islander cardiac patients: associated factors and the impact of perceived social support. ACTA ACUST UNITED AC 2020; 5:e85-e97. [PMID: 32529111 PMCID: PMC7277444 DOI: 10.5114/amsad.2020.95877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
Introduction Cardiac patients frequently experience elevated levels of anxiety, which may influence clinical outcomes. Perceived social support is a precious resource with which to minimise anxiety. The aim of the study was to explore levels of perceived social support, levels of anxiety (state and trait), and the associated factors as well as the impact of patents’ characteristics and social support on anxiety. Material and methods The study sample consisted of 82 island inhabitant patients with cardiac problems (49 men and 33 women). Data collected by the completion of the State-trait anxiety inventory (STAI) and the Multidimensional scale of perceived social support questionnaire (MSPSS). The statistical significance level was set at p < 0.05. Results Regarding state and trait anxiety, half of the patients scored below 37 and 38, respectively, (medians) while 25% of participants scored more than 50 and 48, respectively. These values indicate moderate levels of anxiety. Regarding social support, at least 50% of patients scored over 27, 27, and 20 (median) on support from significant ones, family, and friends, respectively. In addition, 25% of patients scored above 28, 28, and 26, respectively. These values indicate high levels of social support. The association between anxiety and social support was found to be linearly negative, meaning that the more support a patient felt, the less anxiety they also experienced. Conclusions Enhancing perceived social support may be a key-element in alleviating anxiety among cardiac patients.
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21
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Grustam AS, Buyukkaramikli N, Koymans R, Vrijhoef HJM, Severens JL. Value of information analysis in telehealth for chronic heart failure management. PLoS One 2019; 14:e0218083. [PMID: 31220101 PMCID: PMC6586290 DOI: 10.1371/journal.pone.0218083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/26/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Value of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands. METHODS The expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands-patients in all NYHA classes of severity, and patients in NYHA IV class only. RESULTS The population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses. CONCLUSIONS Results of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities.
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Affiliation(s)
- Andrija S. Grustam
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Professional Health Solutions & Services Department, Philips Research, Eindhoven, the Netherlands
- * E-mail:
| | - Nasuh Buyukkaramikli
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Ron Koymans
- Professional Health Solutions & Services Department, Philips Research, Eindhoven, the Netherlands
| | - Hubertus J. M. Vrijhoef
- Department of Patient & Care, Maastricht UMC, Maastricht, the Netherlands
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea b.v., Amsterdam, the Netherlands
| | - Johan L. Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute of Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Li J, Yang P, Fu D, Ye X, Zhang L, Chen G, Yang Y, Luo H, Chen L, Shao M, Li C, Liu Y, Zhou Y, Jiang H, Li X. Effects of home-based cardiac exercise rehabilitation with remote electrocardiogram monitoring in patients with chronic heart failure: a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e023923. [PMID: 30842109 PMCID: PMC6429917 DOI: 10.1136/bmjopen-2018-023923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Patients with chronic heart failure (CHF) can benefit from exercise rehabilitation (ER) with significant improvements in exercise capacity, quality of life and reduction in hospitalisations. Despite its reported benefits, only a small number of patients with CHF attend ER due to poor adherence, and improper exercise may even lead to adverse events. Remote ECG monitoring system (REMS) has the potential to overcome these obstacles. We hypothesise that home-based cardiac ER using REMS in CHF patients is effective compared with conventional ER without monitoring. METHODS AND ANALYSIS This study is a prospective, randomised, parallel controlled clinical trial designed to evaluate the effectiveness of home-based phase-II ER with REMS in the treatment of CHF with a target enrolment of 120 patients (left ventricular ejection fraction <50%, New York Heart Association (NYHA) classes I to III). Patients are randomised to either REMS rehabilitation group or conventional rehabilitation group in a 1:1 ratio. All patients start an exercise training in a supervised setting and then transition to a home-based regimen. The supervised training phase consists of 12 supervised training sessions, three sessions per week for 4 weeks. During the home exercise phase, patients exercise five times per week for 8 weeks. In the REMS group, patients wear monitors during exercise to ensure that exercise intensity is within the set ranges. REMS will also detect risky arrhythmia and alert the patients and their doctors on time. The training intensity is not monitored in the conventional rehabilitation group. The primary outcome is exercise capacity improvement measured by peak oxygen uptake (VO2 peak) (baseline vs 3 m). Secondary outcomes include 6-min walk test, NYHA classes, echocardiographic parameters, cardiac biomarkers, major adverse cardiovascular events, quality of life, psychological well-being and patients' adherence to the rehabilitation programme. ETHICS AND DISSEMINATION This study was approved by Ethics Committee of China-Japan Friendship Hospital for Clinical Research (No. 2018-55 K39). The results of this study will be disseminated via peer-reviewed publications and presentations at conferences. TRIAL REGISTRATION NUMBER ChiCTR-RNR-17012446; Pre-results.
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Affiliation(s)
- Jiahui Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Peng Yang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Dongliang Fu
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojun Ye
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Lifang Zhang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Gang Chen
- Department of Rehabilitation, China-Japan Friendship Hospital, Beijing, China
| | - Yiyun Yang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - He Luo
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Li Chen
- Phase I Clinical Ward of Clinical Trial Research Center, China-Japan Friendship Hospital, Beijing, China
| | - Mingjing Shao
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Chunyan Li
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yi Liu
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Ying Zhou
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Hong Jiang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xianlun Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
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Andrès E, Talha S, Zulfiqar AA, Hajjam M, Ervé S, Hajjam J, Gény B, Hajjam El Hassani A. Current Research and New Perspectives of Telemedicine in Chronic Heart Failure: Narrative Review and Points of Interest for the Clinician. J Clin Med 2018; 7:jcm7120544. [PMID: 30551588 PMCID: PMC6306809 DOI: 10.3390/jcm7120544] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background: This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of heart failure, with special attention placed on remote monitoring of second-generation projects and trials, particularly in France. Results: Since the beginning of the 2000’s, several telemedicine projects and trials focused on chronic heart failure have been developed. The first telemedicine projects (e.g., TEN-HMS, BEAT-HF, Tele-HF, and TIM-HF) primarily investigated telemonitoring or for the older ones, telephone follow-up. Numerous second-generation telemedicine projects have emerged in Europe over the last ten years or are still under development for computer science heart failure, especially in Europe, such as SCAD, OSICAT, E-care, PRADO-INCADO, and TIM-HF2. The E-care telemonitoring project fits within the telemedicine 2.0 framework, based on connected objects, new information and communication technologies (ICT) and Web 2.0 technologies. E-care is the first telemedicine project including artificial intelligence (AI). TIM-HF2 is the first positive prospective randomized study with regards to EBM with positive significant clinical benefit, in terms of unplanned cardiovascular hospital admissions and all-cause deaths. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects.
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Affiliation(s)
- Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, 1 porte de l'Hôpital, 67091 Strasbourg Cedex, France.
- Equipe de recherche EA 3072 "Mitochondrie, Stress oxydant et Protection musculaire", Faculté de Médecine de Strasbourg, Université de Strasbourg (Unistra), 4 rue Kirschleger, 67091 Strasbourg, France.
| | - Samy Talha
- Equipe de recherche EA 3072 "Mitochondrie, Stress oxydant et Protection musculaire", Faculté de Médecine de Strasbourg, Université de Strasbourg (Unistra), 4 rue Kirschleger, 67091 Strasbourg, France.
- Service de Physiologie et d'Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, 1 porte de l'Hôpital, 67091 Strasbourg CEDEX, France.
| | - Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Gériatrie et Thérapeutique, CHU de Rouen, 76000 Rouen, France.
| | | | - Sylvie Ervé
- Centre d'expertise des Technologies de l'Information et de la Communication pour l'autonomie (CENTICH) et Mutualité Française Anjou-Mayenne (MFAM), 49000 Angers, France.
| | - Jawad Hajjam
- Centre d'expertise des Technologies de l'Information et de la Communication pour l'autonomie (CENTICH) et Mutualité Française Anjou-Mayenne (MFAM), 49000 Angers, France.
| | - Bernard Gény
- Equipe de recherche EA 3072 "Mitochondrie, Stress oxydant et Protection musculaire", Faculté de Médecine de Strasbourg, Université de Strasbourg (Unistra), 4 rue Kirschleger, 67091 Strasbourg, France.
- Service de Physiologie et d'Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, 1 porte de l'Hôpital, 67091 Strasbourg CEDEX, France.
| | - Amir Hajjam El Hassani
- Equipe de recherche EA 4662 "Nanomédecine, Imagerie, Thérapeutiques", Université de Technologie de Belfort-Montbéliard (UTBM), 25200 Belfort-Montbéliard, France.
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Boulestreau R, Lalanne P, Durieux W, Delarche N. [Prescription of furosemide in general medicine in Aquitaine: Prospective practice survey among universities general practitioners]. Ann Cardiol Angeiol (Paris) 2018; 67:327-333. [PMID: 30292441 DOI: 10.1016/j.ancard.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Furosemide is essential in the management of patients with congestive heart failure, and provides important iatrogenic complications. We described the prescription of this treatment in general medicine, and tried to identify areas for optimizing its use. PATIENTS AND METHOD We carried out a prospective inventory of the prescription of furosemide with the general practitioners of the universities of Bordeaux, between May 1, 2017 and July 30, 2017. RESULTS We obtained data from 119 prescriptions of furosemide. The indications seemed well known, largely dominated by heart failure (67%) and its associated signs (24%). Clinical and biological follow-up (52%) and therapeutic education (42%) seemed relatively infrequent. CONCLUSIONS Our study confirms the central role of the general practitioner in the prescription of furosemide, the predominant place of heart failure in its indications and the iatrogeny observed. We identified areas of optimization of the safety and effectiveness of the treatment. The reinforcement of training concerning heart failure and its treatments, a better communication between specialties, the implementation of reference systems dedicated to the prescription of furosemide and prescription support software seem promising.
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Affiliation(s)
- R Boulestreau
- Service de cardiologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
| | | | - W Durieux
- Département de médecine générale, université de Bordeaux - campus carreire, 146, rue Léo-Saignat, 33000 Bordeaux, France.
| | - N Delarche
- Service de cardiologie, centre hospitalier de Pau, 4, boulevard Hauterive, 64000 Pau, France.
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Huitema AA, Harkness K, Heckman GA, McKelvie RS. The Spoke-Hub-and-Node Model of Integrated Heart Failure Care. Can J Cardiol 2018; 34:863-870. [DOI: 10.1016/j.cjca.2018.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
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