Remote Monitoring of Patients With Heart Failure: A White Paper From the Heart Failure Society of America Scientific Statements Committee

Dickinson, Michael G.; Allen, Larry A.; Albert, Nancy; DiSalvo, Thomas G.; Ewald, Gregory A.; Vest, Amanda R.; Whellan, David J.; Zile, Michael R.; Givertz, Michael M.

doi:10.1016/j.cardfail.2018.08.011

Cited by 77 publications

(74 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, not all off-the-shelf technologies demonstrate evidence of effectiveness or successful adoption [ 7 , 10 , 11 ]. Despite mixed reviews on their efficacy, enthusiasm for emerging technologies continues among researchers and interventionists [ 12 ]. The popularity with real-time interventions, interoperability with electronic health records, and personalization features persist, generating voluminous amounts of data.…”

Section: Introductionmentioning

confidence: 99%

“I Like the Idea of It…But Probably Wouldn’t Use It” - Health Care Provider Perspectives on Heart Failure mHealth: Qualitative Study

et al. 2020

View full text Add to dashboard Cite

Background Many mobile health (mHealth) technologies exist for patients with heart failure (HF). However, HF mhealth lacks evidence of efficacy, caregiver involvement, and clinically useful real-time data. Objective We aim to capture health care providers’ perceived value of HF mHealth, particularly for pairing patient–caregiver-generated data with clinical intervention to inform the design of future HF mHealth. Methods This study is a subanalysis of a larger qualitative study based on interviewing patients with HF, their caregivers, and health care providers. This analysis included interviews with health care providers (N=20), focusing on their perceived usefulness of HF mHealth tools and interventions. Results A total of 5 themes emerged: (1) bio-psychosocial-spiritual monitoring, (2) use of sensors, (3) interoperability, (4) data sharing, and (5) usefulness of patient-reported outcomes in practice. Providers remain interested in mHealth technologies for HF patients and their caregivers. However, providers report being unconvinced of the clinical usefulness of robust real-time patient-reported outcomes. Conclusions The use of assessments, sensors, and real-time data collection could provide value in patient care. Future research must continually explore how to maximize the utility of mHealth for HF patients, their caregivers, and health care providers.

show abstract

Section: Introductionmentioning

confidence: 99%

“I Like the Idea of It…But Probably Wouldn’t Use It” - Health Care Provider Perspectives on Heart Failure mHealth: Qualitative Study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…As the number of patients with heart failure grows and services are increasingly overstretched, telehealth is often depicted as a partial solution [1,2]. A key determinant of outcome in heart failure is the proportion of patients on maximum tolerated therapy [3], but most heart failure patients are on sub-optimal doses of medication [4,5].…”

Section: Introductionmentioning

confidence: 99%

Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework

Papoutsi

A’Court

Wherton

et al. 2020

Trials

View full text Add to dashboard Cite

Background The SUPPORT-HF2 randomised controlled trial compared telehealth technology alone with the same technology combined with centralised remote support, in which a clinician responds promptly to biomarker changes. The intervention was implemented differently in different sites; no overall impact was found on the primary endpoint (proportion of patients on optimum treatment). We sought to explain the trial’s findings in a qualitative evaluation. Methods Fifty-one people (25 patients, 3 carers, 18 clinicians, 4 additional researchers) were interviewed and observed in 7 UK trial sites in 2016–2018. We collected 110 pages of documents. The analysis was informed by the NASSS framework, a multi-level theoretical lens which considers non-adoption and abandonment of technologies by individuals and challenges to scale-up, spread and sustainability. In particular, we used NASSS to tease out why a ‘standardised’ socio-technical intervention played out differently in different sites. Results Patients’ experiences of the technology were largely positive, though influenced by the nature and severity of their illness. In each trial site, existing services, staffing levels, technical capacity and previous telehealth experiences influenced how the complex intervention of ‘telehealth technology plus centralised specialist remote support’ was interpreted and the extent to which it was adopted and used to its full potential. In some sites, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. Elsewhere, the new model was actively resisted and the technology little used. In one site, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. Conclusions Complex socio-technical interventions, even when implemented in a so-called standardised way with uniform inclusion and exclusion criteria, are inevitably implemented differently in different local settings because of how individual staff members interpret the technology and the trial protocol and because of the practical realities and path dependencies of local organisations. Site-specific iteration and embedding of a new technology-supported complex intervention may be required (in addition to co-design of the user interface) before such interventions are ready for testing in clinical trials. Trial registration BMC ISRCTN Registry 86212709. Retrospectively registered on 5 September 2014

show abstract

“…A key determinant of outcome in heart failure is the proportion of patients on maximum tolerated therapy [3], but most heart failure patients are sub-optimal doses of medication [4,5]. The efficacy of telehealth solutions for heart failure has been widely studied in randomised controlled trials (RCTs), some but not all of which have shown a small benefit over usual care, as measured (for example) by reduced hospital admissions [1,2]. Where benefit has been demonstrated, it has generally been attributed to more timely and detailed provision of biomarker data (e.g.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Where benefit has been demonstrated, it has generally been attributed to more timely and detailed provision of biomarker data (e.g. blood pressure, weight, oxygen saturation), which allows prompt adjustment of medication in response to indicators of decompensation [2]. A new generation of trials has focused on exploring and optimising the human component of the telehealth intervention [6,7].…”

Section: Introduction Backgroundmentioning

confidence: 99%

Explaining the mixed findings of a randomised trial of telehealth with centralised remote support for heart failure: qualitative evaluation

Papoutsi¹,

A’Court²,

Wherton³

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundCentralised specialist remote support, in which a clinician responds promptly to biomarker changes, could potentially improve outcomes in heart failure. The SUPPORT-HF2 trial compared telehealth technology alone with the same technology combined with centralised remote support. The intervention was implemented differently in different sites; no significant impact was found overall. We sought to explain these findings in a qualitative evaluation. Methods51 people (25 patients, 3 carers, 18 clinicians and 4 additional research staff) were interviewed and observed in 7 SUPPORT-HF sites across UK between 2016 and 2018. We also collected 110 pages of documents. Analysis was informed by sociotechnical theory. ResultsPatients’ experiences of the technology were largely positive; staff engaged with the intervention to a variable degree. Existing services, staffing levels, technical capacity and previous experience with telehealth all influenced how the complex intervention of ‘telehealth technology plus centralised specialist remote support’ was interpreted and the extent to which it was adopted and used to its full potential. In some settings, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. However, in some settings, the new care model was actively resisted and the technology little used. In one setting, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. ConclusionsThe introduction of a telehealth programme rests not only on the technological intervention but also on the individuals involved and numerous subtle aspects of local service design. An iterative approach that attends to patients’ illness experiences, clinicians’ professional values, work practices and care pathways could lead to more effective telehealth support for patients with heart failure.

show abstract

Remote Monitoring of Patients With Heart Failure: A White Paper From the Heart Failure Society of America Scientific Statements Committee

Cited by 77 publications

References 77 publications

“I Like the Idea of It…But Probably Wouldn’t Use It” - Health Care Provider Perspectives on Heart Failure mHealth: Qualitative Study

“I Like the Idea of It…But Probably Wouldn’t Use It” - Health Care Provider Perspectives on Heart Failure mHealth: Qualitative Study

Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework

Explaining the mixed findings of a randomised trial of telehealth with centralised remote support for heart failure: qualitative evaluation

Contact Info

Product

Resources

About