Debate on remote patient monitoring remains

Studies have produced conflicting evidence about the value of implantable, external and wearable telemonitoring devices, but speakers at the American College of Cardiology’s (ACC’s) 65^th annual Scientific Session in Chicago expressed belief in the devices’ potential to save lives and help patients manage their own conditions.

Deepak Bhakta, MD, with Indiana University Health in Indianapolis, was creative in giving a quick summary of the research on implantable cardioverter defibrillators (ICDs). “Hidden data or [opening a] can of worms?” Bhakta said. “My answer, unequivocally, is ‘Yes.’’

The program was led by Robert Bourge, MD, professor of medicine, radiology and surgery and vice chair for clinical affairs and development in the department of medicine at the University of Alabama in Birmingham.

He explained that the premise behind implantable-monitor technology is that fluid congestion of the heart is associated with more symptoms and poorer survival and that continuous monitoring can detect problems long before a heart-failure event.

Bourge said heart-failure management can reduce hospitalizations and improve quality of life. But it has its limits. “It’s not a treatment,” he said, it’s a monitor.

The ultimate goal of this monitoring is to improve patients’ quality of life through symptom relief while decreasing healthcare costs by avoiding hospitalizations, said ACC President-elect Mary Walsh, MD, medical director of the heart failure and cardiac transplantation programs and director of nuclear cardiology at the St. Vincent Heart Center in Indianapolis.

Weight gain often leads to hospitalization for heart patients, and Walsh spoke about using electronic scales that can alert care managers if patients’ weight goes up.

Walsh added that patients in the hospital are often told their weight in kilograms which is often meaningless to them. They need to know it pounds which is what they’re familiar with. It’s important to learn how patients think and to get them engaged.

“Self-care is the absolute crux,” she said in explaining the value of weight monitoring. “When a patient gets it, we’re successful.”

There was some discussion about how some patients don’t cooperate and don’t take actions like transmitting the necessary data to care managers. Sometimes they’re just not engaged, but there can also be underlying reasons.

Bourge recalled a patient who had gained 15 pounds. The physician said he was somewhat embarrassed about approaching her and asking why she wasn’t monitoring her weight as recommended. When Bourge did finally talk to the patient, he learned she wasn’t monitoring weight due to affordability of a scale.

“You have to be sensitive about how you ask the question,” Bourge said.