One feature of the mHealth Summit has been a focus on specific disease states, with diabetes and heart disease finding a frequent spotlight due to their respective population burden and associated costs.
In a session moderated by Dr. William Riley, a program director in the Division of Cardiovascular Sciences at NHLBHI, leaders in remote monitoring for cardiovascular disease discussed their insights and experience. Several of these proved quite surprising.
The focus on cardiovascular disease has been generally split between heart failure and coronary disease. As far as heart failure goes, much of the focus at the summit has been preventing 30-day readmission for these patients, which will soon become very costly for hospitals.
In contrast, risk factor modification has taken center stage with coronary artery disease, with some hints at future development of novel surveillance modalities for MI’s.
Dr. Joseph Cafazzo, from the Center for Global eHealth Innovation, discussed data collected from a home monitoring system for hypertension. Perhaps one of the most interesting results was that while improvement was seen in SBP, it was achieved without medication changes. A similar study of home monitoring for heart failure showed improvement in physiologic parameters without additional intervention (e.g. medication changes). The conclusion, while somewhat speculative, is that remote monitoring may, in and of itself, drive behavioral changes – like medication compliance and dietary changes – that are beneficial.
However, as far as behavioral changes go (even compliance with the remote monitoring platforms), Dr. Cafazzo notes that certain diseases, in his experience, have been easier to tackle than others. Heart failure and pregnancy, where consequences are immediate, have been areas where compliance is easier to achieve whereas essential hypertension, where consequences are extraordinarily remote, has been more challenging.
These interventions can be quite remote, as demonstrated by Dr. Piette’s study on home blood pressure monitoring that utilized patient calls originating in areas such as Michigan to patients as far away as Venezuela. A stunning conclusion of his study was that a striking difference exists in efficacy based on health literacy–with low literacy patients garnering bigger benefits.