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MedTech Outlook | Tuesday, March 15, 2022
Modern technological advancements have created new options for telemedical care in conjunction with medical therapy of patients with heart failure.
FREMONT, CA: Heart failure (HF) is a clinical syndrome characterized by shortness of breath, swelling of the ankles, and fatigue, which may be accompanied by signs such as increased jugular venous pressure, pulmonary crackles, and peripheral edema. Even in the asymptomatic phase, patients may develop pre-existing structural or functional cardiac abnormalities—systolic or diastolic left ventricular (LV) dysfunction—that can progress to overt HF. Globally, the estimated absolute number of people suffering from HF approaches 26 million, and this prevalent disease is now found in both developed and developing countries. Chronic heart failure (CHF) patients are high-risk populations for frequent hospitalizations and poor prognoses; indeed, only 10 percent of these patients survive ten years after diagnosis. Annually, 1 million patients are hospitalized with a primary diagnosis of HF, resulting in a total medicare expenditure in the US of more than $17 billion. Numerous physiological predictors of HF severity include increased filling pressures, jugular venous pressure, orthopnea, and echocardiographic filling patterns hospitalizations. Cardiovascular biomarkers and cardiac troponins may also predict readmission risk, especially if they remain elevated following hospital discharge. Neurohormonal activation markers, such as high levels of catecholamines and renin-angiotensin system metabolites or decreased serum sodium, can also be used to identify patients at risk. Increased diuretic requirements or intolerance to neurohormonal antagonists resulting from hypotension or renal dysfunction are likely indicators of disease progression and imply deteriorating clinical outcomes. Additionally, high atrial or ventricular arrhythmia burden decreased heart rate variability, and the development of changes in electrocardiographic traces have been identified as predictors of decompensation events.
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Telemedicine, telemonitoring, mobile health (mHealth), and electronic health (eHealth) have all gradually entered the landscape of clinical medicine over the last decade. Telemedicine began in the clinical management of patients when blood glucose meters, Holter monitoring, event recorders, and 24-hour blood pressure monitoring were introduced. Early on, it became clear that monitoring patients' parameters outside of the hospital setting could be an effective way to prevent cardiac decompensation events, particularly in a high-risk population such as HF patients. The de-medicalization of data has been accomplished through technological advancements and device miniaturization. These advancements have resulted in a sea change in the final data users, who have morphed into patients themselves. This is commonly referred to as telemonitoring, home monitoring, or remote patient monitoring in the modern era (RPM). Telemonitoring can be continuous or sporadic and can depend on the patient's actions or be completely autonomous and automated. The first non-invasive telemedical systems enabled physiological data and parameters—e.g., body weight, heart rate, blood pressure, and body temperature to telemedical centers for data integration by collecting data indirectly via phone calls to patients. Nowadays, more advanced non-invasive systems are capable of measuring and transmitting data obtained non-invasively via electrocardiographic (ECG) tracings, oxygen saturation, blood pressure, and physical activity—e.g., pedometer, as well as invasively via implantable devices, which enable the transfer of variables such as impedance analysis and pulmonary artery or left atrial pressures. Telemonitoring can also be classified as active or passive. While passive telemonitoring is common for invasive implantable devices that send data to the receiving physician sporadically or continuously, active telemonitoring via non-invasive devices requires an action—e.g., a video call self-measurement—e.g., blood pressure measurement by the patients. Implantable telemonitoring devices for multiple parameters or cardiac hemodynamic activity monitoring have been demonstrated to avoid frequent hospitalizations effectively. Rather than that, the role of non-invasive methods for remote monitoring of HF patients is still being debated. Several studies conducted over the last decade have attempted to determine whether telemedical interventions and telemonitoring programs could affect HF patient mortality and re-hospitalizations.
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