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Tedeschi A, Palazzini M, Trimarchi G, Conti N, Di Spigno F, Gentile P, D’Angelo L, Garascia A, Ammirati E, Morici N, Aschieri D. Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts. J Clin Med 2024; 13:2592. [PMID: 38731120 PMCID: PMC11084728 DOI: 10.3390/jcm13092592] [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: 03/28/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients' deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence.
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Affiliation(s)
- Andrea Tedeschi
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
| | - Matteo Palazzini
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Nicolina Conti
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Francesco Di Spigno
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
| | - Piero Gentile
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Luciana D’Angelo
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Andrea Garascia
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Enrico Ammirati
- “De Gasperis” Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (M.P.); (N.C.); (P.G.); (L.D.); (A.G.); (E.A.)
| | - Nuccia Morici
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
| | - Daniela Aschieri
- Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (F.D.S.); (D.A.)
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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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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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Restivo A, D'Amario D, Paglianiti DA, Laborante R, Princi G, Cappannoli L, Iaconelli A, Galli M, Aspromonte N, Locorotondo G, Burzotta F, Trani C, Crea F. A 3-Year Single Center Experience With Left Atrial Pressure Remote Monitoring: The Long and Winding Road. Front Cardiovasc Med 2022; 9:899656. [PMID: 35770220 PMCID: PMC9236153 DOI: 10.3389/fcvm.2022.899656] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite continuous advancement in the field, heart failure (HF) remains the leading cause of hospitalization among the elderly and the overall first cause of hospital readmission in developed countries. Implantable hemodynamic monitoring is being tested to anticipate the clinical exacerbation onset, potentially preventing an emergent acute decompensation. To date, only pulmonary artery pressure (PAP) sensor received the approval to be implanted in symptomatic heart failure patients with reduced ejection fraction. However, PAP's indirect estimation of left ventricular filling pressure can be inaccurate in some contexts.MethodsThe VECTOR-HF study (NCT03775161) is examining the safety, usability and performance of the V-LAP system, a latest-generation device capable of continuously monitoring left atrial pressure (LAP). In our center, five advanced HF patients have been enrolled. After confirmation of the transmitted data reliability, LAP trends and waveforms have guided therapy optimization. The aim of this work is to share clinical insights from our center preliminary experience with V-LAP application.ResultsOver a median follow-up time of 18 months, LAP–based therapy optimization managed to reduce intracardiac pressure over time and no hospital readmission occurred. This result was paralleled by an improvement in both functional capacity (6MWT distance 352.5 ± 86.2 meters at baseline to 441.2 ± 125.2 meters at last follow-up) and quality of life indicators (KCCQ overall score 63.82 ± 16.36 vs. 81.92 ± 9.63; clinical score 68.47 ± 19.48 vs. 83.70 ± 15.58).ConclusionPreliminary evidence from V-LAP application at our institution support a promising efficacy. However, further study is needed to confirm the technical reliability of the device and to exploit the clinical benefit of left-sided hemodynamic remote monitoring.
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Affiliation(s)
- Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Domenico D'Amario
| | - Donato Antonio Paglianiti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Cappannoli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Iaconelli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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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: 27] [Impact Index Per Article: 9.0] [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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Oliveros E, Brailovsky Y, Scully P, Nikolou E, Rajani R, Grapsa J. Coronavirus Disease 2019 and Heart Failure: A Multiparametric Approach. Card Fail Rev 2020; 6:e22. [PMID: 32944292 PMCID: PMC7479531 DOI: 10.15420/cfr.2020.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a debilitating viral infection and, to date, 628,903 people have died from it, numbers that cannot yet be compared to the 50 million who died in the 1918 flu pandemic. As COVID-19 became better understood, cardiovascular manifestations associated with it were identified. This led to a complete healthcare restructuring with virtual clinics and changes to the triaging of critically ill patients. There are a lot of questions over how COVID-19 affects patients with heart failure (HF) as this condition is a leading cause of cardiovascular death. This review describes the cardiovascular implications of COVID-19 and new practices surrounding the use of telehealth to follow up and triage patients with HF. Current practices supported by medical societies, the role of angiotensin-converting enzyme inhibitors and, finally, a brief note regarding the management of advanced HF patients will also be discussed.
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Affiliation(s)
- Estefania Oliveros
- Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York, NY, US
| | - Yevgeniy Brailovsky
- Center for Advanced Cardiac Care, Columbia University Irving Medical Center New York, NY, US
| | - Paul Scully
- Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust London, UK.,4. Institute of Cardiovascular Sciences, University College London London, UK
| | - Evgenia Nikolou
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, UK
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King's College London London, UK
| | - Julia Grapsa
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust London, UK
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Foti F, Vetrugno G, De-Giorgio F, Cicconi M. Consent for elective surgery: audiovisual devices could be used. BMJ 2020; 370:m3158. [PMID: 32788196 DOI: 10.1136/bmj.m3158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Federica Foti
- Risk Management Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 - 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 - 00168 Rome, Italy
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Michela Cicconi
- Risk Management Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 - 00168 Rome, Italy
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