August 26, 2021, by Naveen Acharya, MD, FACC

Introduction:

After decades of innovation in cardiovascular care and reductions in mortality, deaths due to cardiovascular disease have started to increase again in the United States, driven by patients in rural communities who have less access to healthcare resources¹(Figure 1).  While acute life-saving therapies are better than ever before, chronic aftercare remains a challenge and is complex for patients to understand and navigate.  Remote patient monitoring with telehealth holds the promise of addressing multiple points of failure along the spectrum of the cardiovascular care continuum as we face increasing rates of cardiovascular disease burden and wide disparities in the apportioning of healthcare resources.

Figure 1.

Rising cardiovascular disease mortality rates for people who are living in rural areas, middle-aged (45–54 years of age), and white. Authors’ analysis using data from the National Vital Statistics System.³

Source:  Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association, Mark McClellan, Nancy Brown, Robert M. Califf, John J. Warner; Jan2019; Circulation. 2019;139:e44–e54

The importance of remote patient monitoring:

It is well-known that patients with chronic illnesses, like congestive heart failure, have improved survival, less hospital admissions and better quality of life measures when they are more engaged with their self-management with the help of care coordinators and caregivers³.  Given the proliferation of web-based devices and sensors which have become relatively easy for patients to utilize, remote patient monitoring provides the technology required to sufficiently engage patients with caregivers, who can use such platforms for both objective and subjective assessments of their chronic illnesses.  The implementation of a well-designed remote patient monitoring platform has been cited as one of the key interventions capable of addressing the multiple points of failure that exists in the care continuum of cardiovascular disease¹

IntelliH has the necessary features to address nearly all of the cited failure points in cardiac care.

IntelliH:

IntelliH is a SaaS based Remote Patient Monitoring platform with a focus on proactively managing chronic cardiac conditions like CHF. It provides a risk stratified dashboard for care coordinators on PC, MAC and Android tablets. The intelliHpatient App on iOS and Android devices wirelessly collects physiological data from monitoring devices such as Weight Scales, Pulse Oximeters, Blood Pressure Monitors, Thermometers as well as Glucometers and sends that to IntelliH on the cloud for analysis. The IntelliH platform tracks care plans, analyzes received vitals and generates alerts that are customized to an individual patient. It prepares a comprehensive disease specific report for doctors to analyze across any longitudinal period. The IntelliH solution enables immersive collaboration with patients, care givers and care teams through rich telehealth videos as well as secure texts.

IntelliH addresses failure points by closing the gaps:

Focusing on preventive treatments across populations can have dramatic effects on reducing cardiovascular disease burden.This further translates into reduced healthcare expenditure per patient which in turn is a significant source of bonus revenue for healthcare systems participating in shared savings programs.  intelliHwas constructed with the understanding that bringing patients closer to their caregivers through the platform in the clinical context of the incoming vitals data would possibly alter the course of their illness and avert adverse outcomes compared to traditional fragmented, episodic care.  Specific failure points have been identified by the American Heart Association¹ and intelliH has functions that are capable of meeting the needs they have identified (Figure 2):

1. Failure to make risk factor modifications: Understanding trends in patients’ vitalsis paramount to controlling risk factors. Measurements in physician’s offices are often erroneous due to factors such as anxiety or incorrect measurements.  intelliHinterfaces with FDA approved wireless sensors, to automatically import patients’ vitals on a daily basis, so that true biometrics are visible to care providers for more targeted risk factor modification.
2. Failure to elicit and follow people’s goals and needs:intelliH has specific goals that can be programmed in the system by care providers so that patients are aware of exactly which range their biometrics such as weight, blood pressure or heart rate should be. Alerts can be set to be triggered for care coordinators in the event these biometric parameters fall out of range, so that targeted steps can be taken to maintain patients’clinical stability through their chronic illness.
3. Failure to diagnose:intelliHwas designed to be device agnostic and is capable of integrating with a wide variety of wireless sensors, including ECG monitors to record a patient’s cardiac rhythm. Depending on the particular sensor connected intelliH can facilitate the diagnosis of new conditions that may be present as a result of an underlying cardiac condition.
4. Failure to use proven first-line therapies: Conditions such as atrial fibrillation are often missed due to infrequent and sporadic recordings of the patient’s cardiac rhythm.intelliHcan use integrated sensors with the capacity to diagnose new conditions so that proven therapies such as anticoagulation, in the case of atrial fibrillation, can be implemented to avert adverse events such as strokes.
5. Failure to use advanced treatments: Because real-time vitals data is captured through intelliHthe data can be used to understand and correlate with the specific medications being utilized.  Thus, in a shorter period of time caregivers can understand which therapies are more effective than others and if necessary more advanced therapeutics can be implemented to achieve the desired level of control of the underlying condition.
6. Failure to provide supportive care:One of the most critical aspects of controlling chronic illness is to properly gain patients’ trust through a close caregiver-patient relationship. In the modern world, several obstacles interfere with the creation of an effective relationship including geographic, cultural and socioeconomic barriers.  Remote patient monitoring with telehealth engagement tools, which are seamlessly integrated through the intelliHplatform, are vital for promoting closer relationships and engagements with patients so that effective education can be provided and proper oversight of care plans can be achieved to ensure that patients are supported throughout their illness, effectively leading to better long-term outcome and quality of life metrics.

Figure 2:

• intelliH provides real-time
• IntelliH alerts including SMART Alerts help care givers respond immediatelyto out of bound vitals
• IntelliH is device agnostic and can integrate with a variety of diagnostic sensors
  such as wireless ECG machines that can detect conditions like a fib. to use proven Rx
• IntelliH combines RPM with patient engagement like multi-party video-conferencing
  solutions to support a personalized care plan for the specific needs of a patient
• IntelliH analytics can be used to determine the correct medical regimen individualized for each patient

The Importance of Care Co-ordination:

When patients are diagnosed with their chronic illnesses, usually in the inpatient setting, and have to go home and manage a complicated medication regimen which is largely foreign to them, they are faced with the daunting challenge of having to navigate a complex healthcare system of which they often have little education about.   A system of care coordination after discharge from the acute care setting is vital to ensure that patients do not succumb to decompensation from their illness due to a lack of sufficient understanding of how to use their treatment recommendations.  The following four characteristics of an optimal care-coordination system, all of which are successfully addressed by intelliH, have been shown to improve outcomes²:

1. Frequent interaction with patients: IntelliH connects care coordinators with patients in real-time using multi party video conferencing and secured messaging technology that can leverage the clinical strength of multiple care team members around the patient.
2. Appropriate risk stratification: intelliHcan be configured to combine risk information from the severity of vitals received along with thetimeline and chronicity of alerts with the underlying disease specific risk profile of the patient to help caregivers focus on the most at need patients.
3. Targeted education: intelliH analytics can display vitals with relevant medication data to educate patients how to properly take their prescribed medication regimen
4. Effective transitional care management: intelliHcan be connected to multiple EMR systems in order to obtain information post discharge from the acute care episode to create a customized care plan for patients so that the continuum of care extends after hospitalization into the patient’s residence with appropriate oversight from the care team.

Conclusions:

The burden of cardiovascular disease continues to increase in the United States.  The supply of cardiologists, however, to address this demand is insufficient⁴.  Furthermore, the training of the workforce may not be sufficiently calibrated to address the specific needs of the increasing prevalence of chronic cardiovascular disease.  Several solutions have been proposed to address this problem.  Twoin particular are addressed by the architecture of intelliH.  First, cardiologists should be integratedwithin a care team comprising of primary care physicians, nurse practitioners, physician assistants and pharmacists.  Second, prevention should be a focus to reduce the subsequent proliferation of cardiovascular disease that occurs without the appropriate management of risk factors.  intelliH was built to create care teams and improve care coordination with the purpose of managing chronic cardiovascular disease with the timely management of risk factors through real-time analysis of vitals.  While the acute shortage of cardiologists will take some time to address, technology such as that present in intelliHhas the potential to make the existing workforce more efficient to help bridge the supply and demand mismatch that exists today in the cardiology workforce.

References:

1. Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association, Mark McClellan, Nancy Brown, Robert M. Califf, John J. Warner; Jan2019; Circulation. 2019;139:e44–e54
2. Peikes D, Chen A, Schore J, Brown R. Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials. 2009;301(6):603–618. doi:10.1001/jama.2009.126
3. Zan S, Agboola S, Moore SA, Parks KA, Kvedar JC, Jethwani K. Patient engagement with a mobile web-based telemonitoring system for heart failure self-management: a pilot study. JMIR MhealthUhealth. 2015 Apr 1;3(2):e33. doi: 10.2196/mhealth.3789. PMID: 25842282; PMCID: PMC4398882.
4. Narang A, Sinha SS, Rajagopalan B, et al. The Supply and Demand of the Cardiovascular Workforce: Striking the Right Balance. J Am Coll Cardiol. 2016;68(15):1680-1689. doi:10.1016/j.jacc.2016.06.070

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