Elderly couple with healthy heart at home

Remote Management of Heart Failure

Remote patient monitoring enables earlier detection of decompensation, improved adherence to lifestyle and medication adjustments, and interventions that reduce the need for hospitalization and overall all cause mortality.

Heart failure (HF) is becoming more common worldwide, carries a high admission rate and places a significant financial strain on healthcare resources. Remote Patient Monitoring (RPM) has shown to improve the care and outcome of heart failure patients in many studies. HF accounts for about 2% of the healthcare expenditure in European and North American countries. According to predictions, the total cost of HF in the United States will climb by nearly 130 percent to US$70 billion per annum by 2030. Much work has been paid to detecting decompensation of the HF condition before an emergency hospital admission is required. Individuals and families who want to improve their self-monitoring and management skills should participate in illness management programs that include education and support, according to international guidelines. A stage of subclinical hemodynamic decompensation commonly precedes readmission for decompensated HF, where therapeutic measures could avert clinical decompensation and hospitalization. Structured telephone support, advanced telemonitoring technology, remote monitoring of patients with implanted cardiac devices, and implantable hemodynamic monitors are all examples of remote patient monitoring approaches that are foreseen to assist patients with HF.

What is heart failure?

Heart failure occurs when the heart is unable to pump enough blood to meet the needs of the body. This can happen if the heart cannot get enough blood to fill up the chambers of the heart. It can also happen if the heart is not strong enough to pump blood adequately. Heart failure does not imply that the heart has stopped functioning, but it is a dangerous illness that necessitates medical attention.

Heart failure can strike acutely or gradually as the heart weakens. One or both sides of the heart may be affected. The causes of left-sided and right-sided heart failure may be different. The most common causes of heart failure that rescinds the heart include coronary heart disease, inflammation of the heart, excessive blood pressure, cardiomyopathy, or an irregular heartbeat. Symptoms of heart failure may not appear instantaneously. However, patients will eventually become weary and short of breath, and edematous in the lower body, stomach, or neck.

What causes heart failure?

Many medical problems that damage the heart muscle can lead to cardiac failure. The common causes of heart failure include hypertension, coronary artery disease, acute coronary syndrome, congenital heart disease, cardiomyopathy, arrhythmias, diabetes, obesity, kidney failure, tobacco, illicit drug use and certain medications like chemotherapeutic drugs.

Hypertension is one of the most common causes of heart failure. The force of blood pumping against the walls of your blood vessels is known as blood pressure. The pressure in the arteries is higher than normal if high blood pressure is present. The heart needs to work harder to pump blood into the body when the blood pressure is high. This can cause the left ventricle to thicken or stiffen, resulting in heart failure and can potentially lead to heart disease.

Coronary artery disease is another cause of heart failure. Coronary artery disease damages the arteries that supply blood and oxygen to the heart, which can start with atherosclerosis at an early age. The course of the disease starts when the natural lining inside the arteries breaks down, the artery walls thicken, and fat deposits form. The arteries constrict or become fully clogged over time, resulting in a heart attack. The obstruction prevents the heart from pumping enough blood to maintain the organs and tissues of the body to be healthy, including the heart. When arteries get blocked, patients may have chest pain and other heart disease symptoms.

Cardiomyopathy is another cause of heart failure. The damage and swelling of the heart muscle that is not caused by problems with the coronary arteries or blood flow is referred to as cardiomyopathy. Certain viruses, alcohol or drug addiction, smoking, genetics, and pregnancy are all potential causes of cardiomyopathy that may lead to heart failure.

What are the symptoms of heart failure?

The pumping motion of the heart is responsible for delivering oxygen and nutrient-rich blood to the cells of the body. The body cannot function normally when the cells are not properly nourished. The weaker heart of patients with heart failure cannot pump enough blood into the cells. This causes weariness, shortness of breath, and coughing in some patients during ordinary activities like walking, stair climbing, and other movements. Patients with HF may also experience palpitations because the heart may beat faster to try to get enough oxygen-rich blood to vital organs and muscles if the heart muscle does not pump with adequate force. Weight gain and edema in the ankles, legs, and abdomen may also happen in patients with heart failure when the kidneys are not able to filter enough blood and the body retains excess fluid and water. Patients with HF when lying flat and have extra fluid in their lungs are prone to having a dry hacking cough. Patients with HF may have symptoms that are minor or no symptoms at all. Heart failure symptoms can range from moderate to severe, and symptoms can be paroxysmal. Heart failure, in general, worsens over time. Patients may experience more and different signs and symptoms as the disease worsens. It is critical to notify the healthcare provider if new symptoms develop or if current symptoms worsen to address them immediately and prevent progression.

What is the course of patients with heart failure?

Heart failure may limit the activities of patients with heart failure, but with the correct care and medication, many patients can still enjoy life to the fullest. The state of the heart muscle, symptoms, and how well the patient responds and follows the treatment plan all influence the well-being of patients with HF. The treatment plan that includes taking medications, regular exercise, eating a low-sodium diet, and keeping track and reporting new or worsening symptoms to the healthcare professional all result in a better outcome for patients with heart failure. And because heart failure is a chronic, long-term illness, constant monitoring and easy access to medical care are imperative.

What is the role of remote patient monitoring in patients with heart failure?

As technology progresses, more comprehensive attempts to remotely monitor heart failure have become possible. This enables earlier detection of decompensation, improved adherence to lifestyle and medication adjustments, and interventions that reduce the need for hospitalization. Remote patient monitoring has opened up a world of possibilities. Collecting data remotely and finding a mechanism to integrate such potentially continuous data streams into care systems, as well as converting more data into improved decision-making that improves the outcome or experience of care with the help of remote patient monitoring, is becoming more popular.

In TIM-HF2, telemonitoring was found to have a positive influence. Patients with HF were randomly assigned to receive standard care or a multicomponent telemonitoring home system that sent weight, blood pressure, heart rate, cardiac rhythm, oxygen saturation, and self-rated health status to treating clinicians on a daily basis. Patients got HF information as well as monthly structured telephone interviews to assess their condition. Patients were also given HF education as well as monthly structured phone interviews to monitor their clinical condition and medicines. In this trial, adherence was higher: 97 percent of patients were 70 percent compliant with daily data transfer, and unexpected cardiovascular hospitalizations and all-cause mortality were significantly reduced.

Takeaway

Heart failure is becoming more common worldwide and may pose some limitations on the activities of patients with heart failure. But with the correct care and medication, many patients can still enjoy life to the fullest. Aggressive titration of guideline-directed medical therapy based on symptoms, blood pressure, and laboratory results to achieve maximum-tolerated dosages to improve symptoms, reduce hospitalizations, and increase survival is the cornerstone of HF management. Remote patient monitoring enables earlier detection of decompensation, improved adherence to lifestyle and medication adjustments, and interventions that reduce the need for hospitalization.

References:

Soundarraj D, Singh V, Satija V, Thakur RK. Containing the costs of heart failure management: a focus on reducing readmissions. Heart Fail Clin. 2017;13:21–8. doi: 10.1016/j.hfc.2016.07.002.

Benjamin EJ, Virani SS, Callaway CW et al. Heart disease and stroke statistics – 2018 update. A report from the American Heart Association. Circulation. 2018;137:e67–492. doi: 10.1161/CIR.0000000000000558.

Koehler F, Koehler K , Deckwart O , et al . Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018;392:1047–57.doi:10.1016/S0140-6736(18)31880-4

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