In remote treatment of heart failure patients, good technology is not enough

During the American Heart Association Scientific Sessions in Philadelphia this month, researchers and healthcare leaders highlighted the potential of digital tools to improve the care of heart failure patients.

Emily Seto speaks about remote patient monitoring at the American Heart Association Scientific Sessions in Philadelphia Nov. 11. (Photo: Ron Southwick)

Researchers highlighted the use of remote patient monitoring programs to track patients with heart disease and potentially intervene before the appearance of more serious complications or problems that could lead to long or expensive hospital stays.

Researchers shared some insights into the development of Medly, a new digital company based in Canada. Medly’s smartphone-based remote patient management helps heart failure patients track key indicators, such as their blood pressure, heart rate and blood sugar.

Heather Ross, head of cardiology at the Peter Munk Cardiac Center in Toronto, spoke about the value of remote monitoring in Canada, where some patients may have to fly for hours to get to the hospital.

“When we manage patients, we see them and then we book an appointment, three months, six months, and then we see them at that appointment,” Ross said. “And the problem is that the patients don’t get sick during these kinds of time windows. They have their own kind of schedule, and what we really need is to change that paradigm from an episode to an on-demand care.”

She noted some studies that found lower-than-expected adherence to remote patient monitoring was often associated with the lack of integration into medical practice.

Emily Seto, an associate professor at the University of Toronto who co-invented Medly’s technology, spoke about the importance of thinking about workflows and making it easy for patients to follow remote patient monitoring programs.

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“Good technology is necessary but not sufficient,” Seto said.

Patients have generally found Medly’s technology to be user-friendly, Seto said. Patients say the app is straightforward and simple to use, especially after using it a few times.

“Once in a while we have some technology issues. And of course, when that happens, it’s a terrible experience,” Seto said.

“But in reality, in the studies that we’ve found some negative patient experiences, it really hasn’t been because of technology,” she added. “It is about the implementation of the program. So unfortunately there are many, many ways to implement to go sideways.”

Researchers talked about the importance of inspiring clinicians and how to present the remote monitoring program to patients.

“How the program is positioned and presented by the clinical team is really important,” Seto said. “This will really convince whether patients and caregivers even want to try the program and especially adhere as we go years or months.”

Patients in remote patient monitoring programs also need to be able to reach clinicians quickly with questions and concerns, Seto said. Issues of “timely action” on data and alerts can be problematic, she said.

“If you don’t get this immediate feedback clinically to the patient, they lose confidence,” Seto said.

Patients with heart failure often have other chronic conditions. Seto said that after patients are discharged from the hospital, they are given Medly’s remote monitoring and also paired with a nurse who can help provide holistic care to patients with other chronic conditions and can refer them for further treatment if needed.

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When remote monitoring is managed effectively, patients communicate more frequently and effectively with their doctors, and they also gain a sense of comfort.

“It gives peace of mind. And it reduces anxiety,” Seto said.

Done effectively, telemonitoring patients can spend less time traveling to see their doctors, which can become a serious problem for those with long trips to their providers (which is common in parts of Canada) and for those with limited funds.

Ross discussed the importance of devising remote monitoring programs for patients with underserved and disadvantaged communities in mind. “If we don’t, we will continue to drive disparities in care,” Ross said.

“Health equity needs to be an explicit goal,” Ross said.

Seto noted some equity hurdles that need to be overcome to make Medly’s remote monitoring more accessible to a wider audience. As she noted, the Medly app is currently only available in English and requires some level of literacy. Some potential solutions involve voice recognition technology and translation capabilities.

But for now, the solution is not available to others who could benefit from it, Seto said.

“We’re talking about people who may be homeless,” Seto said. “We are talking about people who may have mental health problems or cognitive impairments.”

To address gaps and reduce the risk of widening disparities, remote monitoring programs must be carefully designed, Ross said.

“There is no one-size-fits-all,” Ross said. “You have to tailor to society, the patient and the health system.”

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