In Remote Treatment of Heart Failure Patients, Good Technology Isn’t Enough

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

Emily Seto talks 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 emergence of more serious complications, or issues that could lead to lengthy or costly hospital stays.

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

Heather Ross, head of cardiology at the Peter Munk Cardiac Centre in Toronto, talked 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 patients don't get sick in that kind of time window. They have their own kind of schedule and what we really need is to change this 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 linked to the lack of integration into physician practices.

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

“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 when they’ve used it a couple of times.

“Occasionally we do have some technological issues. And of course, when that happens, it becomes a terrible experience,” Seto said.

“But in reality, in the studies that we have found some negative patient experience, it really has not been because of technology,” she added. “It's around the implementation of the program. So unfortunately, there are many, many ways of deployment to go sideways.”

Researchers talked about the importance of inspiring buy-in from clinicians, and how they present the remote monitoring program to patients.

“It's really important the way that the program is positioned and presented by the clinical team,” Seto said. “This will really persuade whether patients and the caregivers want to even try the program and especially adhere as we go along for 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 with “timely action” to data and alerts can be problematic, she said.

“If you don't get this immediate feedback clinically for the patient, they lose trust,” Seto said.

Patients with heart failure often have other chronic conditions. Seto said 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 for patients with other chronic conditions, and can direct them to additional care if needed.

When remote monitoring is managed effectively, patients communicate more often and effectively with their physicians, and they also get a sense of comfort.

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

Done effectively, patients with remote monitoring can spend less time traveling to see their doctors, which can become a serious issue for those with lengthy trips to their providers (which is common in parts of Canada) and for those with limited means.

Ross discussed the importance of devising remote patient monitoring programs with underserved and disadvantaged communities in mind. “If we don’t, we are going to continue to drive inequities in care,” Ross said.

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

Seto noted some equity hurdles to overcome to make Medly’s remote monitoring more accessible to wider audiences. As she noted, the Medly app is only available in English at this time, and it requires a degree of literacy. Some potential solutions involve voice recognition technology and translation capabilities.

But for now, the solution isn’t accessible to others who could benefit from it, Seto said.

“We're talking about people who may be homeless,” Seto said. “We're talking about people who may have amental health issues or cognitive impairments.”

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

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