mHealth and heart failure

We also tried it with heart failure patients. My colleague Emily Seto further developed the system to include more parameters such as weight and ECG. In her randomized controlled trial of 100 heart failure patients the remote monitoring group took daily weight and blood pressure readings, weekly single-lead ECGs, and answered daily symptom questions on a mobile phone for 6 months. Quality of life measured with the Minnesota Living with Heart Failure Questionnaire improved only for the telemonitored group (decrease of 9 points, p=.02).

A subgroup analysis found that only the telemonitored group had significant improvements in Brain Natriuretic Peptide (BNP) (decreased by 150 pg/mL, p=.02), left ventricular ejection fraction (LVEF_ (increased by 7.4%, p=.005), and self-care maintenance (increased by 7 points, p=.05) and management (increased by 10 points, p=.03).

Patient, heal thyself

We were amazed to learn that the physicians had very little do with the outcome. There weren’t any significant changes in medications or management of the patient. This was truly patient self-care.

How so? The patient interviews revealed that the monitoring system helped patients improve their self-care knowledge and helped them to correlate and modify their lifestyle behavior according to changes in weight, blood pressure, and symptoms. Patients found the portability of the system to be beneficial, and several patients took the monitoring system on vacation. Clinicians thought the system helped them manage their patients, particularly through medication changes.

We believe that patients became more self-aware of their condition over the course of the study. The reminders, the regular measurements, the messaging, kept them engaged and likely more adherent to the medications that they were already prescribed, and to the life style changes that they needed to make.

The perceived accountability to the physician was also likely powerful. The automated messages when they didn’t take their readings may have given them the impression they were being watched (i.e. accountable). Although it was entirely triggered through a rule set, the patients likely felt an obligation to the provider to use the system.

What about the control group in the hypertension study who were given just the blood pressure monitor? Like most attempts along these lines, without the sense of engagement or accountability, they likely ended up in a drawer somewhere, with no appreciable change in their BP after a year.

Conclusion

In summary, the findings from the trial have provided evidence of improved clinical management and health outcomes from mobile phone-based remote monitoring, which support the findings from recent meta-analyses and the terrific WellDoc study recently published. These results support the implementation and further research of such systems as a cost-effective and portable tool compared to traditional remote monitoring systems for chronic disease management.

In the second part of this series, we present our results in terms of engagement and compliance with the hardest group of all: kids.

These studies were sponsored by the Heart and Stroke Foundation of Canada, The Toronto General and Western Hospital Foundation, and Saint Elizabeth Healthcare with in-kind contributions from Research In Motion and Telus Health.

Video

Contact:

Joseph Cafazzo, PhD PEng
Lead, Centre for Global eHealth Innovation, Toronto General Hospital
Assistant Professor, Institute of Biomaterials and Biomedical Engineering and the Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto
Twitter: @josephcafazzo

Citations

Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ
Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring
J Med Internet Res 2012;14(1):e25
URL: http://www.jmir.org/2012/1/e25/

Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ
Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial
J Med Internet Res 2012;14(1):e31
URL: http://www.jmir.org/2012/1/e31/

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