mark ledwidge - heartbeat trust
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HeartPhone – positioning remote patient monitoring in Heart Failure ecosystem Dr. Mark Ledwidge, Research Director, Heart Failure Unit, St Vincent’s University HospitalSept 16th, 2011
Agenda
» Our journey in remote patient monitoring
» Challenges and opportunities
» What does the ecosystem need
Heart Failure – Ideal for remote patient monitoring
Hospitalisation rates for heart failure 1971-2000 (NHLBI) age stratified rates US
1-2% of population, high readmission rates, many are preventable
Manual Remote Patient Monitoring
0
510
15
20
25
3035
4045
50
Rich '93 Rich '95 Stewart '99 McDonald 02
Even
t Rat
e (%
)
RCMC
» Components – outbound calls from trained healthcare professional, home weight monitoring
Weight monitoring in HF
2 Kg over 2-3 days
Weight monitoring in HF
» Only 20% sensitive» Non adherence > 30-50% » Assumes all patients are the same» Most weight gains are too subtle
2 Kg over 2-3 days
Weight monitoring in HF
2 Kg over 2-3 days
TENS-HMS
Remote Patient monitoring
TelemonitoringUsual Care
Cleland et al JACC 2005;45(10):1654–64
Heartphone
» Collaboration
Crofton Cardiac Systems
DAILY WEIGHT
Heartphone
DAILY WEIGHTTRENDS ANALYSIS
Heartphone
DAILY WEIGHTTRENDS ANALYSIS
7/7 NURSE/REGISTRAR REVIEW
CARDIOLOGIST REVIEW
Heartphone
DAILY WEIGHTTRENDS ANALYSIS
CARDIOLOGIST REVIEW
ADDITIONAL INPUTS
Heartphone
7/7 NURSE/REGISTRAR REVIEW
Large spread of patients
Large spread of patients
Mr BF, West Cork
Mr BF, West Cork
Unstable, high risk
Referrals to GP
Mr BF, West Cork
Unstable, high risk
Referrals to GP
Multiple GP referrals to hospital, no heart failure unit in CUH, 6 months echo waiting list, diagnostic BNP unavailable
Compliance <50%, confidence reduced
Mr BF, West Cork
Ecosystem not primed
Ecosystem primed
» TENS-HMS
Ecosystem not-primed
» Tel-HF
The hype is over
Challenges
» Soft endpoints do not convince payers in heart failure care
» The Ecosystem needs integration
» Evidence base needs to evolve
Opportunity - improve the algorithm
Better sensitivity
Manual Weight Monitoring Guideline Remote Weight Monitoring
Algorithm Remote Weight Monitoring
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No AlertAlert
Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions
Opportunity - improve the algorithm
Manual Weight Monitoring Guideline Remote Weight Monitoring
Algorithm Remote Weight Monitoring
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No AlertAlert
Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions
Better sensitivity
Opportunity - improve the algorithm
Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions
Manual Weight Monitoring Guideline Remote Weight Monitoring
Algorithm Remote Weight Monitoring
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No AlertAlert
**P<0.001
Better sensitivity**
**
Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
Opportunity - Demographics
20101 in 1060+ yrs old
30
20501 in 5
Opportunity – 80% of what we do
Chronic disease, mostly managed poorly
Opportunity – 80% of what we do
Chronic disease, mostly managed poorly
Opportunity - Economics
0 5 10 15 20 25 30
All
Circulatory
CHD
Angina
Acute MI
Chronic CHD
Heart failure
Stroke
Diabetes
Cancer
Colorectal cancer
Lung cancer
Breast cancer
Bladder cancer
Nervous sytem
Respiratory
Digestive
GU
Injury & poisoningM
ain
diag
nosi
s
Number of inpatient days
Opportunity - Economics
» ‘Healthcare Unbound’, Forrester
2010 20150
5
10
15
20
25
30
35
40
Remote personal health mon-itoring
$ Bi
llion
PA
Opportunity - multimarkers
» 5 question daily patient reported outcome
Opportunity - multimarkers
» 5 question daily patient reported outcome » Other peripherals: BP, glucometer, pulse
Oximeter
» Improve the algorithm» Reduce workload
Opportunity - multimarkers
Opportunity - multimarkers
Opportunity – this cannot continue
Opportunity – integrated ecosystem
Patients
Government 3rd party payers
service providers,clinicians
Suppliers
Devices,Technical,Regulatory
Carers
Patient Centred Care
“It’s not an intrusion. It’s a great feeling of security.”
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