Heart failure is a common condition that occurs when the heart doesn’t pump as well as it should. More than five million Americans are currently living with heart failure and about 500,000 new cases are diagnosed in the U.S. each year. Heart failure patients are monitored routinely in their doctor's office by gauging changes in their weight which can indicate fluid building up in the body – a rather crude measure. Patients also sometimes need monitoring of pressures inside the heart, which involves a hospital procedure.
But now, cardiologists at Penn Medicine are testing devices that allow patients to be monitored from the comfort of their own homes instead of having to make trips to and from the hospital.
A sensor is implanted in the heart or one of the lungs to take pressure readings which are transmitted automatically to the doctor’s office by phone. Medications can be adjusted based on the pressure readings. Depending on the severity of the patient's condition, the provider may check these statistics on a daily or weekly basis to determine the best course of treatment.
“We’re studying implantable devices that can monitor and measure pressure and fluid in the body, heart rhythm and rate, along with activity level,” says Lee Goldberg, MD, MPH, medical director, of the Penn Medicine Heart Failure and Transplantation Program. “These devices let us know not only how the patient is doing, but helps us track what they are doing that might be impacting their heart." For example, Goldberg says “If someone eats too much salt during dinner, we’ll see that.”
The devices allow the clinical care team to look at trends in the patient’s day to day progress, changes in their condition over time and then use that data to fine tune management of their disease. “It offers unbelievably personalized treatment and allows the patient the opportunity to be involved in their own care,” he says.
The concept behind “telehealth” monitoring for chronic disease is not entirely new. Doctors have also looked at ways to use remote monitoring for patients with other chronic conditions like diabetes and asthma, but Goldberg says that for heart failure patients, there may be some extra benefits.
“Most of my patients find it comforting and many have said they ‘felt safe, like someone was always looking after them, " he says. Family members also like this kind of care because with this technology, they can be assured their loved one is being monitored as closely as possible. If a patient skips their medications, the supervising physician will know.
He points out that in addition to the security that patient and their families feel, remote monitoring can reduce pressure on resources, particularly for conditions like chronic heart failure, which exert a large burden on health services.
In fact, studies have shown that heart failure is the worse readmission offender in medicine, costing the U.S. health care system approximately $39 billion in direct and in direct costs. Early diagnosis and treatment through the remote monitoring may help to prevent these hospitalizations, improve quality of life for patients and possibly reduce mortality.
“Our long term goal in studying these devices is to look for novel ways to reduce hospital re-admission rates of patients at highest risk for re-hospitalization and help better manage their heart failure symptoms at home.”