We aimed to provide an overview of telemedical monitoring and its impact on outcomes among heart failure (HF) patients. Most HF readmissions may be prevented if clinical parameters are strictly controlled via telemedical monitoring. Predictive algorithms for patients with cardiovascular implantable electronic devices (e.g., Triage-HF Plus by Medtronic or HeartLogic by Boston Scientific) were developed to identify patients at significantly increased risk of HF events. However, randomized control trial-based data are heterogeneous regarding the advantages of telemedical monitoring in HF patients. The likelihood of adverse clinical outcomes increases when pulmonary artery pressure (PAP) rises, usually days to weeks before clinical manifestations of HF. A wireless monitoring system (CardioMEMS™) detecting changes in PAP was proposed for HF patients. CardioMEMS™ transmits data to the healthcare provider and allows to institute timely intensification of HF therapies. CardioMEMS™-guided pharmacotherapy reduced a risk of HF-related hospitalization (hazard ratio [HR]: 0.72; 95% confidence interval (CI) 0.60–0–0.85; p < 0.01). Relevant developments and innovations of telemedical care may improve clinical outcomes among HF patients. The use of CardioMEMS™ was found to be safe and cost-effective by reducing the rates of HF hospitalizations. 

/pdf/telemedical-monitoring-based-on-implantable-devices-the-1h2g1mk6.pdf

Telemedical Monitoring Based on Implantable Devices—the Evolution Beyond the CardioMEMS™ Technology

Background COVID-19 increased the demand for Remote Patient Monitoring (RPM) services as a rapid solution for safe patient follow-up in a lockdown context. Time and resource constraints resulted in unplanned scaled-up RPM pilot initiatives posing risks to the access and quality of care. Scalability and rapid implementation of RPM services require social change and active collaboration between stakeholders. Therefore, a participatory action research (PAR) approach is needed to support the collaborative development of the technological component while simultaneously implementing and evaluating the RPM service through critical action-reflection cycles. Objective This study aims to demonstrate how PAR can be used to guide the scalability design of RPM pilot initiatives and the implementation of RPM-based follow-up services. Methods Using a case study strategy, we described the PAR team’s (nurses, physicians, developers, and researchers) activities within and across the four phases of the research process (problem definition, planning, action, and reflection). Team meetings were analyzed through content analysis and descriptive statistics. The PAR team selected ex-ante pilot initiatives to reflect upon features feedback and participatory level assessment. Pilot initiatives were investigated using semi-structured interviews transcribed and coded into themes following the principles of grounded theory and pilot meetings minutes and reports through content analysis. The PAR team used the MoSCoW prioritization method to define the set of features and descriptive statistics to reflect on the performance of the PAR approach. Results The approach involved two action-reflection cycles. From the 15 features identified, the team classified 11 as must-haves in the scaled-up version. The participation was similar among researchers (52.9%), developers (47.5%), and physicians (46.7%), who focused on suggesting and planning actions. Nurses with the lowest participation (5.8%) focused on knowledge sharing and generation. The top three meeting outcomes were: improved research and development system (35.0%), socio-technical-economic constraints characterization (25.2%), and understanding of end-user technology utilization (22.0%). Conclusion The scalability and implementation of RPM services must consider contextual factors, such as individuals’ and organizations’ interests and needs. The PAR approach supports simultaneously designing, developing, testing, and evaluating the RPM technological features, in a real-world context, with the participation of healthcare professionals, developers, and researchers.

Scaling-up digital follow-up care services: collaborative development and implementation of Remote Patient Monitoring pilot initiatives to increase access to follow-up care

http://www.onlinejcf.com/article/S1071916421004656/pdf

Emerging Implantable-Device Technology for Patients at the Intersection of Electrophysiology and Heart Failure Interdisciplinary Care

Concurrent Assessment of the CardioMEMS™ HF System and HeartLogic™ HF Diagnostic: A Retrospective Case Series

Concurrent Assessment of the CardioMEMS HF System and HeartLogic HF Diagnostic: A Retrospective Case Series.

AIMS: Remote patient monitoring (RPM) in the management of heart failure (HF), including telemonitoring, thoracic impedance, implantable pulmonary artery pressure (PAP) monitors, and cardiac implantable electronic device (CIED)-based sensors, has had varying outcomes in single platform studies. Uncertainty remains regarding the development of single-centre RPM programs; additionally, no studies examine the effectiveness of dual platform RPM programs for HF. This study describes the implementation and outcomes of a dual platform RPM program for HF at a single centre. METHODS AND RESULTS: An RPM program was developed to include two platforms (e.g. CardioMEMS™ HF System and HeartLogic™ HF Diagnostic). To examine changes within each participant over time, study-related outcomes including total hospitalizations (TH), total length of stay (TLOS), cardiac hospitalizations (CH), cardiac LOS (CLOS), and cardiac-related emergency department (ED) visits were compared in two timeframes: 12 months pre-enrolment and post-enrolment into RPM. For 141 participants enrolled, there was a significant reduction in the likelihood of experiencing a CH by 19% (0.77 vs. 0.61 events/patient-year; HR: 0.81, 95% CI: 0.67-0.97, P = 0.03) and a cardiac-related ED visit by 28% (0.48 vs. 0.34 events/patient-year; HR: 0.72, 95% CI: 0.55-0.93, P = 0.01). There was also a 51% decrease (SE = 1.41, 95% CI: 2.79-8.38 days, P < 0.001) and 62% decrease (SE = 1.24, 95% CI: 3.35-8.22 days, P < 0.001) in TLOS and CLOS, respectively. CONCLUSIONS: A dual platform RPM program for HF using structured education, RPM-capable devices, and alert-specific medication titration reduces the likelihood of experiencing a cardiac hospitalization and cardiac-related ED visit in this single-centre study.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ehf2.13214

Development and implementation of a remote patient monitoring program for heart failure: a single-centre experience.

Remote patient monitoring (RPM) is a method using sensor technologies to observe patients through wearable devices (Malasinghe et al., 2017; Agnisarman et al., 2017) that measure and track essential patient vitals such as heart rate, respiration rate, and blood pressure readings in real-time. The advantages of using RPM are early detection of health conditions, the ability to continuously monitor patients, the prevention of deteriorating health and untimely deaths, and the reduced number of hospitalizations (Malasinghe et al., 2019). Because healthcare providers can continuously monitor the patient, medication or lifestyle changes can be easily recommend; for these reasons, RPM has become increasingly utilized in patients with heart failure (HF), a condition that affected approximately 26 million individuals in 2020, a number predicted to increase by more than 8 million by 2030 (Bowen et al., 2020). Through observation of the real-time vital measurements provided by RPM, health care professionals can quickly diagnose and treat heart failure patients remotely with increased efficiency, thus improving patient care. Several devices are currently available that can monitor the heart, each manufactured by a different company. These various devices also use different methods to measure the health of the patient. As this suggests, healthcare professionals must know the values obtained as well as how to operate and interpret data from multiple platforms. One benefit of these multiple platforms is the flexibility they offer for the patient, important because insurance companies often specify the devices they will cover. If a provider uses only one RPM system and it is not covered by the patient’s insurance, they must pay the full price for the system or find a provider who uses the device covered by their insurance. This tradeoff adds complexity to the system for both the healthcare provider and the patient. The complexity of multi-system RPM is further compounded by the use of new technology, multiple interfaces and device types, the accuracy of the data obtained, patient adherence, and the lack of information available about the devices. Since RPM is a relatively new and rapidly growing area in the healthcare domain, many healthcare professionals are not aware of the capabilities and limitations of RPM. Furthermore, healthcare professionals are familiar with and have been trained on the standard methods for in-person monitoring, but not on RPM. Effective implementation of RPM systems requires healthcare providers to adapt their knowledge in a different way. As a result, most healthcare providers who have RPM capabilities use one system comprised of one device and a corresponding interface. However, Carolina Cardiology Consultants, the medical group studied here, uses multiple devices. These healthcare professionals must know how all of these systems work and how to navigate through their corresponding interfaces. This challenge that Carolina Cardiology Consultants faces is rare. Another challenge associated with RPM, one that is of utmost importance to healthcare providers, is the accuracy of the data being recorded. In some cases, external factors can affect the readings. Specifically, one of the main challenges in this area is to obtain a clean signal from a patient’s body (Malasinghe et al, 2019). The devices can be easily influenced based on the patient’s body position and external electrical signals such as ECG monitors and metal bedside railings. This means that the healthcare provider is also responsible for checking the accuracy of the reading by knowing what is considered normal and abnormal behavior for a given device. RPM systems are classified as either active or passive. Passive systems monitor and record patient values without requiring any action from the patient. These systems have the capability to automatically store, forward, and analyze data collected on a regular basis (Field et al., 2002). In contrast, active systems require that the patient do some sort of active data entry. For example, requiring patients to input values, such as their weight. Some patients forget to record readings or simply do not adhere to a regular reading schedule. Regularly scheduled readings are important because they ensure that the healthcare providers have accurate and useful insights about their patient’s condition. Past research in RPM has typically focused on the patient’s perception of RPM systems (Narasimha et al., 2017), meaning there is little understanding of the barriers and facilitators of RPM from a healthcare provider perspective. Additionally, past literature has primarily focused on the use of one RPM system, not several. This gap in the research in this domain makes the implementation of safe RPM systems more difficult for healthcare providers. Further, there is limited research suggesting areas for improvement when implementing multi-system RPM procedures. To address these limitations, the objective of this study is to identify the barriers, facilitators, and effect of the caregiving process on patient safety for three RPM multi-platform systems used by Carolina Cardiology Consultants (CCC) in Greenville, South Carolina, specifically, CarelinkTM by Medtronic, Merlin.netTM by Abbott, and LATITUDE NXTTM by Boston Scientific.

Barriers and Facilitators in Implementing Multiplatform Remote Heart Failure Patient Monitoring Systems in Clinical Settings

The 1-Year Effects of Tafamidis on Clinical, Echocardiographic, and Scintigraphic Parameters: A Retrospective Analysis of a Single-Center Experience

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Development and implementation of a remote patient monitoring program for heart failure: a single-centre experience.

Barriers and Facilitators in Implementing Multiplatform Remote Heart Failure Patient Monitoring Systems in Clinical Settings

The 1-Year Effects of Tafamidis on Clinical, Echocardiographic, and Scintigraphic Parameters: A Retrospective Analysis of a Single-Center Experience

Concurrent Assessment of the CardioMEMS HF System and HeartLogic HF Diagnostic: A Retrospective Case Series.