Telemonitoring technologies enable medical teams to remotely manage outpatients with heart failure (HF) and reduce their risk of HF-related hospitalizations. However, noncompliance threatens the ...effectiveness of these approaches. This review aims to identify whether patients who are less likely or unable to comply with telemonitoring and their instructions for use are represented by interventional telemonitoring studies, and if their exclusion from studies is resulting in study findings not representative of clinical reality.
A narrative literature review was conducted to identify interventional telemonitoring studies reporting compliance rates for HF patients. A search of PubMed and Medline databases identified eligible studies published between January 2000 and June 2021.
: Twenty-five (n = 25) eligible studies with an interventional study design were identified. Reported compliance with telemonitoring ranged between 37% and 98.5%; however, 72% of studies reported good or medium compliance. A majority (76%) of studies had exclusion/inclusion criteria favoring the enrollment of patients who may be more likely to comply with telemonitoring and their instructions for use. Forty percent of studies had a sample with a mean or median age of <65 years. Participants were more likely to be male (majority in 92% of studies) and white (majority in 78% of studies that reported ethnicity).
Compliance rates reported by current studies are unlikely to be generalizable to the wider HF population, particularly patients who are less likely or unable to comply with telemonitoring. Studies are therefore likely overestimating compliance rates. Future innovation should focus on designing "low compliance" solutions that require minimal engagement from users and future studies should aim to recruit a more generalizable cohort of patients. To achieve a more standardized metric of compliance, studies should report compliance (however defined) achieved by the 25th, 50th, and 75th percentile of all patients enrolled.
COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for ...patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH).
The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities.
Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools.
Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The ...Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform.
This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making.
With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service.
The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.
The TElemonitoring in the MAnagement of Heart Failure (TEMA-HF) 1 long-term follow-up study assessed whether an initial six-month telemonitoring (TM) programme compared with usual care (UC) would ...result in reduced all-cause mortality, heart failure admissions and healthcare costs in chronic heart failure (CHF) patients at long-term follow-up.
Of the 160 patients included in the multi-centre, randomised controlled telemonitoring trial (TEMA-HF 1, time point t
); 142 CHF patients (65% male; age: 76 ± 10 years; EF: 36 ± 15%) were alive and entered the follow-up study (time point: t
) with a final evaluation at 79 months (time point: t
). Both TM and UC group patients received standard heart failure care during the follow-up study (time points: t
- t
). The primary endpoint was all-cause mortality. Secondary outcomes included days lost due to heart failure readmissions and readmission/patient follow-up related healthcare costs.
Compared with usual care, the initial six-month TM programme had no significant effect on all-cause mortality (hazard ratio: 0.83; 95% confidence interval, 0.57 to 1.20; p = 0.32). The number of days lost due to heart failure readmissions was significantly lower in the TM group ( p = 0.04). Healthcare costs did not differ significantly between the TM (€ 9140 ± 10580) and UC group (€ 12495 ± 22433) ( p = 0.87).
An initial six-month telemonitoring programme was not associated with reduced all-cause mortality in CHF patients at long-term follow-up but resulted in a reduction in the number of days lost due to heart failure readmissions. This study is registered in the ClinicalTrials.gov registry (NCT03171038) (URL: https://clinicaltrials.gov/ct2/show/NCT03171038 ).
Patient decision aids (PDAs) facilitate shared decision-making (SDM) and are delivered in a variety of formats, including printed material or instructional videos, and, more recently, web-based ...tools. Barriers such as time constraints and disruption to clinical workflow are reported to impede usage in routine practice.
This pragmatic study examines use of PDAs integrated (iPDAs) into the electronic health record (EHR) over an 8-year period.
A suite of iPDAs that personalize decision-making was integrated into an academic health system EHR. Clinician use was tracked using patient and clinician encrypted information, enabling identification of clinician types and unique uses for an 8-year period. Clinician feedback was obtained through survey.
Over 8 years, 1,209 identifiable clinicians used the iPDAs at least once ("aware"). Use increased over time, with 2,415 unique uses in 2010, and 23,456 in 2017. Clinicians who used an iPDA with at least 5 patients ("adopters"), increased by 82 clinicians each year (range 56-108); of clinicians who used the tool once, 54.3% became adopters. Of 261 primary care clinicians, 93.5% were aware, 86.2% were adopters, and 80.5% used the tools in the last 90 days. Clinicians perceived the iPDAs to be convenient, efficient, and encouraging of SDM.
We demonstrate that use of decision aids integrated into the EHR result in repeated use among clinicians over time and have the potential to overcome barriers to implementation. We noted a high degree of clinician satisfaction, without a sense of increase in visit time.
Integration of PDAs into the EHR results in sustained use. Further research is needed to assess the impact of iPDAs on decisional quality.
Background: New sensor technologies in wearables and other consumer health devices open up promising opportunities to collect real-world data. As cardiovascular diseases remain the number one reason ...for disease and mortality worldwide, cardiology offers potent monitoring use cases with patients in their out-of-hospital daily routines. Therefore, the aim of this systematic review is to investigate the status quo of studies monitoring patients with cardiovascular risks and patients suffering from cardiovascular diseases in a telemedical setting using not only a smartphone-based app, but also consumer health devices such as wearables and other sensor-based devices. Methods: A literature search was conducted across five databases, and the results were examined according to the study protocols, technical approaches, and qualitative and quantitative parameters measured. Results: Out of 166 articles, 8 studies were included in this systematic review; these cover interventional and observational monitoring approaches in the area of cardiovascular diseases, heart failure, and atrial fibrillation using various app, wearable, and health device combinations. Conclusions: Depending on the researcher’s motivation, a fusion of apps, patient-reported outcome measures, and non-invasive sensors can be orchestrated in a meaningful way, adding major contributions to monitoring concepts for both individual patients and larger cohorts.
Abstract Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 ...health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.
An increasing number of elderly and disabled people urge the need for a health care monitoring system which has the capabilities for analyzing patient health care data to avoid preventable ...deaths. Medical Telemetry is becoming a key tool in assisting patients living remotely where a “Real-time Remote Critical Health Care Monitoring System” (RRCHCMS) can be utilized for the same. The RRCHCMS is capable of receiving and transmitting data from a remote location to a location that has the capability to diagnose the data and affect decision making and further providing assistance to the patient. During the cardiac analysis, several artifacts solidly affect the ST segment, humiliate the signal quality, frequency resolution, and results in large amplitude signals in ECG that simulate PQRST waveform and cover up the miniature features that are useful for clinical monitoring and diagnosis. In this paper, several leaky based adaptive filter structures for cardiac signal improvement are discussed. The Circular Leaky Least Mean Square (CLLMS) algorithm being the steepest drop strategy for dropping the mean squared error gives a better result in comparison with the Least Mean Square (LMS) algorithm. To enlarge the filtering ability some variants of LMS, Normalized Least Mean Square (NLMS), CLLMS, Variable Step Size CLLMS (VSS-CLLMS) algorithms are used in both time domain (TD) and frequency domain (FD). At last, we applied this algorithm on cardiac signals occurred due to MIT-BIH database. The performance of CLLMS algorithm is better compared to LLMS counterparts in conditions of Signal to Noise Ratio Improvement (SNRI), Excess Mean Square Error (EMSE) and Misadjustment (MSD). When compared to all other algorithms VSS-CLLMS gives superior SNRI. These values are 13.5616dB and 13.7592dB for Baseline Wander (BW) and Muscle Artifact (MA) removal.
A non-uniform distribution of diagnostic information in the electrocardiogram (ECG) has been commonly accepted and is the background to several compression, denoising and watermarking methods. Gaze ...tracking is a widely recognized method for identification of an observer's preferences and interest areas. The statistics of experts' scanpaths were found to be a convenient quantitative estimate of medical information density for each particular component (i.e., wave) of the ECG record. In this paper we propose the application of generalized perceptual features to control the adaptive sampling of a digital ECG. Firstly, based on temporal distribution of the information density, local ECG bandwidth is estimated and projected to the actual positions of components in heartbeat representation. Next, the local sampling frequency is calculated pointwise and the ECG is adaptively low-pass filtered in all simultaneous channels. Finally, sample values are interpolated at new time positions forming a non-uniform time series. In evaluation of perceptual sampling, an inverse transform was used for the reconstruction of regularly sampled ECG with a percent root-mean-square difference (PRD) error of 3-5% (for compression ratios 3.0-4.7, respectively). Nevertheless, tests performed with the use of the CSE Database show good reproducibility of ECG diagnostic features, within the IEC 60601-2-25:2015 requirements, thanks to the occurrence of distortions in less relevant parts of the cardiac cycle.
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