A Remote Patient Monitoring System for Congestive Heart Failure

Congestive heart failure (CHF) is a leading cause of death in the United States affecting approximately 670,000 individuals. Due to the prevalence of CHF related issues, it is prudent to seek out methodologies that would facilitate the prevention, monitoring, and treatment of heart disease on a daily basis. This paper describes WANDA (Weight and Activity with Blood Pressure Monitoring System); a study that leverages sensor technologies and wireless communications to monitor the health related measurements of patients with CHF. The WANDA system is a three-tier architecture consisting of sensors, web servers, and back-end databases. The system was developed in conjunction with the UCLA School of Nursing and the UCLA Wireless Health Institute to enable early detection of key clinical symptoms indicative of CHF-related decompensation. This study shows that CHF patients monitored by WANDA are less likely to have readings fall outside a healthy range. In addition, WANDA provides a useful feedback system for regulating readings of CHF patients

Heart rate and blood pressure monitoring in heart failure.

It has been long known that incessant tachycardia and severe hypertension can cause heart failure (HF). In recent years, it has also been recognized that more modest elevations in either heart rate (HR) or blood pressure (BP), if sustained, can be a risk factor both for the development of HF and for mortality in patients with established HF. Heart rate and BP are thus both modifiable risk factors in the setting of HF. What is less clear is the question whether routine systematic monitoring of these simple physiological parameters to a target value can offer clinical benefits. Measuring these parameters clinically during patient review is recommended in HF management in most HF guidelines, both in the acute and chronic phases of the disease. More sophisticated systems now allow long-term automatic or remote monitoring of HR and BP and whether this more detailed patient information can improve clinical outcomes will require prospective RCTs to evaluate. In addition, analysis of patterns of both HR and BP variability can give insights into autonomic function, which is also frequently abnormal in HF. This window into autonomic dysfunction in our HF patients can also provide further independent prognostic information and may in itself be target for future interventional therapies. This article, developed during a consensus meeting of the Heart Failure Association of the ESC concerning the role of physiological monitoring in the complex multi-morbid HF patient, highlights the importance of repeated assessment of HR and BP in HF, and reviews gaps in our knowledge and potential future directions

The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally

Since the 1990s, the Veterans Health Administration (VHA) has used information and communications technologies to provide high-quality, coordinated, and comprehensive primary and specialist care services to its veteran population. Within the VHA, the Office of Telehealth Services offers veterans a program called Care Coordination/Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care management and case management services to veterans with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder, and other conditions. The program uses remote monitoring devices in veterans' homes to communicate health status and to capture and transmit biometric data that are monitored remotely by care coordinators. CCHT has shown promising results: fewer bed days of care, reduced hospital admissions, and high rates of patient satisfaction. This issue brief highlights factors critical to the VHA's success -- like the organization's leadership, culture, and existing information technology infrastructure -- as well as opportunities and challenges

A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy

Background: Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods: The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results: The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. Conclusions: The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Health Care Leader Action Guide to Reduce Avoidable Readmissions

Outlines a four-step approach to reducing avoidable hospital readmissions. Suggests interventions during hospitalization, at discharge, and post-discharge, including patient and caregiver education, multidisciplinary care coordination, and home visits

The effects of short-term omission of daily medication on the pathophysiology of heart failure

Aims Pharmacological therapies for heart failure (HF) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening HF. Characterizing the effects of short-term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening HF. We examined the effect of planned HF medication omission for 48 h on weight, echocardiograms, transthoracic bio-impedance, and plasma concentrations of NT-proBNP. Methods and results Outpatients with stable HF and an LVEF &lt;45% were assigned to take or omit their HF medication for 48 h in a randomized, crossover trial. Twenty patients (16 men, LVEF 32 ± 9%, median NT-proBNP 962 ng/L) were included. Compared with regular medication, omission led to an increase in NT-proBNP by 99% (from 962 to 1883 ng/L, P &lt; 0.001), systolic blood pressure by 16% (from 131 to 152 mmHg, P &lt; 0.001), and left atrial volume by 21% (from 69 to 80 mL, P = 0.001), and reductions in transthoracic bio-impedance by 10% (from 33 to 30 Σ, P = 0.001) and serum creatinine by 8% (from 135 to 118 µmol/L, P = 0.012). No significant changes in body weight, heart rate, or LVEF were observed. Conclusions The characteristic pattern of response to short-term medication omission is of increasing congestion but, in contrast to the pattern reported for disease progression, with a rise in blood pressure and improved renal function. In stable HF, weight is not a sensitive marker of short-term diuretic omission

Novel concepts for non-invasive telemonitoring in chronic heart failure

Background: The morbidity and mortality from chronic heart failure (HF) remains alarmingly high, in part due to failure to apply substantial disease modifying strategies to halt disease progression. Telemonitoring has been proposed as a potential disease management strategy to deal with the burden posed by HF. While treatment decisions guided by invasive telemonitoring data have shown early promise, it is unclear whether non-invasively derived surrogates of haemodynamics could be reliable enough to guide therapeutic interventions.Aims: The principal aim of this thesis is to investigate whether non-invasive “smart technologies” could accurately detect and track subtle changes in surrogates of cardiovascular haemodynamics in response to challenges posed by activities of daily living and non-adherence to therapy. Methodology: A series of prospective clinical studies were conducted in stable patients with chronic heart failure, on optimum tolerated guideline directed therapy for heart failure. Studies were performed under clinically adapted conditions to mimic the patient’s own habitat.Results: Significant systemic haemodynamic perturbations were detected non-invasively with variations in environmental temperature. Additionally, music, which modulates the sympathetic tone, led to modest changes in systemic blood pressure and heart rate, although the changes did not reach statistical significance. Non-adherence to cardiovascular therapy led to striking adverse changes in systemic haemodynamics. Smart technologies demonstrated a remarkable consistency in detecting haemodynamic perturbations.Conclusion: Non-invasive detection and tracking of changes in haemodynamics is feasible with smart technologies. The results need to be validated in larger multicenter clinical trials, with particular emphasis on using the data to guide therapeutic decisions

Monitoring Cardiovascular Disease-Patients with Mobile Computing Technologies

Physicians and healthcare networks have been slow to adopt electronic medical records and to integrate medical data with the ubiquitous mobile device. Mobile and wearable systems for continuous health monitoring constitute a key technology in helping the transition of health care to a more proactive and affordable healthcare. Cardiovascular Disease (CVD) includes dysfunctional conditions of the heart, arteries, and veins that supply oxygen to vital life-sustaining areas/organs of the body. CVD singly accounts for about 40% of all deaths worldwide. Over 80 per cent of CVD deaths take place in low- and middle-income countries. An estimated 17.5 million people died from cardiovascular disease in 2005, and expected to top 20 million per year by 2015. By 2030, more than 23 million people will die annually from CVDs. CVDs‘ patients face risks of recurrent acute cardiovascular events, hospital re-admission, and unfavourable quality of life. Heart Failure, (HF), leads to death if not properly managed and supervised. Current treatments for Congestive Heart Failure (CHF) provide a limited palliative outcome. New technologies are now pertinent to generate high-dimensional data that provide unprecedented opportunities for unbiased identification of biomarkers that can be used to optimize pre-operative planning, with the goal of avoiding costly post-operative complications and prolonged hospitalization. Due to the crucial role of remote monitoring for CVD patients, significant efforts from research communities and industry to propose and design a variety of CVD monitoring devices have become imperative. This paper builds a proof-of-concept and presents a cardiovascular monitoring system, Cardiovascular Disease Management System (CVDMS), for real-time information on patient‘s heart health status with respect to his/her heart beat in hemodynamics computation towards reducing re-admission incidence problem. Administered 485 questionnaires and interviewed 12 cardiologists, 45 physicians, and 23 pharmacists to gather details on vital CVD parameters. 469 of 485 questionnaires (96.70%) were validly completed and returned, while 16 (3.30%) were not. Searched internet databases and cognate texts for literature. A mobile CVDMS for HF was developed using UML, MySQL Server 5.0, Java servlets, Apache Tomcat 6.0 server, microcontroller, and Ozeki sms server. Patient completes a questionnaire on a J2ME platform-based computing device that measures the heartbeat rate. Biological signals acquired by CVDMS are processed by microcontroller. Pulses are counted within a space of one minute to know heartbeat rate per minute. The CVDMS application gets the heartbeat reading, and if the heart rate is abnormal, a trigger is set enabling the Ozeki SMS Gateway to send an alert to patient‘s next-of-kin and cardiologist. CVDMS guarantees individual patient‘s direct involvement to closely monitor changes in his/her vital signs and provide feedback to maintain an optimal health status. Medical personnel get alerted when life-threatening changes occur in establishing proper communication between patient and cardiologist via sms. Hemodynamics computation could be performed with the parameters obtained from the data supplied by CVDMS as a cardiovascular intervention to save many lives and improve quality of life. Keywords: artery stiffness; blood pressure; cardiologist; cardiovascular disease; heart attack; heart failure; hemodynamic volumetric parameters; hospital re-admission; hypertension; risk-factor