Smartphones Aid in Remote Monitoring of Patients With Recent Acute MI

Using smart technology and e-visits for follow-up of patients after an acute MI is feasible, cuts down on wait times for office visits, and supports patients by giving them more of a role in their own healthcare, Dutch researchers conclude. 

“Our trial was in post-myocardial infarction patients, which is a selected patient population,” noted the study’s lead author, Roderick W. Treskes, MD, PhD (Leiden University Medical Center, the Netherlands), in an email. Overall, he said, smart technology devices for use at home “were met with great patient satisfaction,” which confirms that patients can successfully and routinely measure and transmit their own data without the presence or assistance of office staff.

The paper, published online last week in JAMA Network Open, comes at a time when physicians are increasingly depending on telehealth solutions to keep in touch with patients and their symptoms amid the COVID-19 pandemic. Treskes said his group believes there may be unexpected opportunities during this time to gather details regarding duration of e-visits, feasibility, and patient satisfaction.

In the study, 200 patients were randomized to four different types of smartphone-enabled monitoring devices or usual care. At one year, there was no difference between the intervention and control groups in terms of the percentage of patients with BP ≤ 139/89 mm Hg (79% vs 76%; P = 0.64). There also was no difference in the percentage of patients in each group who reported being satisfied with their care (P = 0.88), no difference in all-cause mortality at 1 year (2% in both groups), and no difference in rehospitalizations for nonfatal cardiac events.

In an accompanying editorial, Steven M. Bradley, MD, MPH (Minneapolis Heart Institute, MN), comments that demand for in-person healthcare visits in the United States has been outpacing the ability to provide them. Given both the scope of the aging population and the accompanying rise of chronic diseases, telehealth holds the potential to address several shortcomings in traditional delivery, he writes.

For instance, Bradley notes that in a recent survey, wait times for new office appointments increased by 30% between 2014 and 2017. The average time to a new cardiology appointment equaled or exceeded 14 days in 13 of 15 large metropolitan areas, including Boston (45 days), Portland (32 days), San Diego (30 days), Philadelphia (28 days), Denver (22 days), Minneapolis (22 days), Los Angeles (20 days), Washington, DC (18 days), Atlanta (16 days), Seattle (16 days), New York (15 days), Detroit (14 days), and Miami (14 days).

“An alternative model that leverages a combination of data from the patient’s electronic health record and routinely transmit[s] patient-generated data could obviate the need for many routinely scheduled visits,” Bradley writes.

High Patient Satisfaction Noted

For Treskes et al’s study, patients randomized to the intervention group received a scale for weighing themselves; a Bluetooth BP monitor; a credit-card-sized single-lead ECG device; and a step counter worn on the wrist. They also had two of their four in-person follow-up visits in the year after hospital discharge replaced with e-visits (at the 1-month and 6-month follow-up). During e-visits, which were conducted over tablet, smartphone, or computer, patients saw the same nurse practitioner they saw for their outpatient visits.

Over the 1-year study, the intervention group was asked to continuously record their steps, weigh themselves and take their BP every day as well as to take an ECG each day and record any symptoms of possible cardiac origin. A member of the study team monitored the incoming data, and patients were contacted and told to come in for a visit if their systolic BP exceeded 139 mm Hg, diastolic BP exceeded 89 mm Hg, they had newly diagnosed arrhythmias, or had at least four newly diagnosed symptomatic premature ventricular contractions on the ECG.

Patients also completed a questionnaire that measured their satisfaction with the follow-up care they received, with the intervention group taking a separate questionnaire on their acceptance and adherence to the smart technology. In the intervention group, the majority of patients (90%) reported being satisfied with using the smart technology. Among the individual devices, satisfaction was close to 90% for the BP monitoring, ECG, and scale, but very low for the wrist-worn step counter at 4%. The majority of patients also said they were happy being able to view their own health data.

To TCTMD, Treskes said his team is now using a different step counter for future studies because they believe the low satisfaction rate they saw was related to technical issues with that particular device.

Potential for Better Optimization of Care

In terms of adherence, about one-third of the intervention group transmitted their data each week as requested and 63% transmitted it more than 80% of the 52 weeks of the study.

Importantly, Bradley notes that staying in touch with patients electronically could provide the reassurance they need that their health is being well monitored via the data they generate themselves.

“Furthermore, as the scientific evidence that informs best practices for specific medical conditions evolves, patients affected by changes in the evidence base could be identified via algorithms applied to patient-generated and electronic health record data,” he adds. “This could both shorten the time to optimization of care and eliminate the need for scheduled check-in visits designed to ensure care is up to date.”

Another important point Bradley raises is that not only does the Dutch study show how smart technology can be successfully used and accepted by patients, it also gives insight into why some patients may not want any part of it. When Treskes and colleagues documented the reasons that 75 eligible acute MI patients gave for refusing to participate in the trial, they found that for many of them, fear was at the root of the concern. This included fear of being confronted with their disease too often, as well as fear of not being able to cope with the technology being supplied.

To TCTMD, Treskes said his group believes some of the objections that patients have can be overcome. Moving forward, they are incorporating psychological care as part of the telehealth protocol for those who need it.

“We see this as a psychological challenge, not necessarily a shortcoming of the technology,” he added. “Part of patients’ objections can, to our interpretation, be [attributed] to the unfamiliarity of some patients with smart technology in general. We think that in 5 years, this will not be an issue anymore.”