#6 Telehealth Monitoring for Individuals with Heart Failure/Implanted Wireless Cardiac Device for Monitoring Heart Failure

Overview

A weakening of the heart’s ability to pump blood throughout the body causes heart failure. Between 500,000
and 900,000 new cases are diagnosed each year in the United States, making this debilitating ailment the most
common diagnosis in Medicare patients. Even though great strides have been made in effective identification and medical therapy, the prognosis remains poor for people with heart failure and it accounts for 200,000 deaths
annually. Average life expectancy is less than five years in patients with symptomatic heart failure, while 90% of
those with advanced disease have survival rates of a year.

The most common cause of this incapacitating ailment is heart damage due to coronary artery disease or high blood pressure.

When a person has heart failure, quality of life is minimized. Fatigue, shortness of breath, fluid retention, and excessive urination at night are common symptoms. As the ailment progresses, even mild physical activity becomes exhausting. As fluid accumulates in the lower extremities, swelling of the feet, ankles, legs, and abdomen occur. Older people with heart failure may also experience lightheadedness or confusion.

Despite the dramatic improvements in medical care, heart failure is the leading cause of hospitalizations, with more than one million admissions annually. An even larger problem for the health care system is the re-admission rate. More than 27% of heart failure patients return to the hospital for additional care in the month after first leaving the hospital, while 58% are re-admitted over the course of the next six to 12 months. The estimated direct and indirect costs of this extra medical assistance may be as high as $20 billion.

There are many good heart failure medications. What’s been missing, however, has been the critical information to help physicians adjust the medication when necessary to keep the patient healthy—and out of the hospital. But this is all starting to change, thanks to wireless health care and a variety of technology-based remote patient monitoring devices that are now playing a major role in heart failure management.

Better and more affordable technology is helping to ensure patient adherence to medication schedules and the early detection of signs of decompensation, particularly in the early period after hospital discharge. Various sophisticated methods of assessing heart failure control are now in use or in final testing phases, including an implantable, miniature, permanent monitor with communication technologies that measures and transmits daily pulmonary artery pressure levels, a key indicator of heart health.

A recent Phase III clinical trial of the novel system in patients with New York Heart Association Class III heart failure showed a 30% reduction in rate of hospitalization after six months and a 38% reduction per year. Approval of this device by the Food and Drug Administration is expected in 2011.

In addition, a variety of sophisticated at-home telehealth monitoring devices are being used at home by patients with heart failure to check and transmit real-time body weight, heart rate, and blood pressure results to a secure database for doctors to review with a smartphone or computer.

By utilizing this important information that’s been gathered remotely at home, hospitalizations can then be avoided by readjusting the patient’s medication. This conveniently improves outcomes, reduces costly re-hospitalizations, significantly improves the quality of life of patients, and lessens the huge financial strain placed on the health care system by heart failure.

Where Are They Now

A weakening of the heart's ability to pump blood throughout the body causes heart failure. Between 500,000 and 900,000 new cases are diagnosed each year in the U.S. Wireless healthcare and a variety of technology-based remote patient monitoring devices are now playing a major role in heart failure management, providing a more effective way for physicians to gain critical information about their patient, to adjust medication when necessary, and keep the patient healthy and out of the hospital. Various sophisticated methods of assessing heart failure control are now in use or in final testing phases, including an implantable, miniature, permanent monitor with communication technologies that measures and transmits daily pulmonary artery pressure levels, a key indicator of heart health.

Currently, about 47% of patients with implantable devices use remote monitoring. This number is expected to grow as remote monitoring can be set up at a regular hospital visit with a device configuration update. The remote patient monitoring market grew by nearly 44 percent in 2016, and the market is currently valued at $31.4 billion. In a 2016 published study that looked at the ‘most wired’ hospitals in the country, a growing percentage of hospitals that employ internet-enables monitoring devices for chronic disease management of congestive heart failure and heart disease was observed. 

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