Remote Monitoring Programs for Cardiac Conditions

Abstract


 Remote monitoring is a type of telehealth whereby health care is delivered to patients outside traditional settings by allowing health data to be exchanged between patients and health care providers using telecommunication techniques (e.g., video conferencing) or stand-alone devices (e.g., portable heart rate monitors). The goals of remote monitoring centre around promoting home-based self-management to improve patient outcomes and/or reduce health system usage.
 CADTH’s Health Technology Assessment included the following analyses:
 
 A Realist Review: This sought to identify key perceived or actual mechanisms of remote monitoring programs. Substantial evidence was available regarding the use of remote monitoring programs for heart failure (n = 64) and cardiac rehabilitation (n = 23), limited evidence was available for atrial fibrillation (n = 4), and none was available for hypertension.
 A Perspectives and Experiences Review: This thematic synthesis of primary qualitative research sought to understand and describe peoples’ experiences with and perspectives on remote monitoring programs for cardiac conditions. CADTH also engaged patients and caregivers directly in a patient engagement section.
 An Ethics Review: This sought to identify and reflect upon key ethical issues that should be considered when contemplating the implementation of remote monitoring programs.
 
 
 Overall, the vast majority of sampled patients, caregivers, and health professionals consistently found or perceived remote monitoring programs across different cardiac conditions to be easy to use and beneficial to health.
 Remote monitoring programs may be an attractive adjunct as opposed to an alternative to existing health professionals and services.
 Although remote monitoring programs may ultimately reduce avoidable hospitalizations, they may increase net costs and workload during set-up and operational phases without careful pathway design and expectations management.
 More research is needed to identify the costs and cost-effectiveness of remote monitoring programs across chronic cardiac conditions.

Remote monitoring for long-term physical health conditions: an evidence and gap map

“…There was a greater volume of synthesised research on interventions where data were passed on via app, website, e-mail or patient portal, or automatically, than methods such as telephone calls or SMS. This perhaps reflects the fact that remote monitoring is often a form of digital innovation, and that a key aim of these interventions is to improve the efficiency of health care, 9,45 for example through reducing re-admissions. 21 There were further concentrations of evidence synthesis relating to feedback, with feedback being most likely to be provided via a telephone call, and from a nurse, if the healthcare professional involved was reported.…”

Virtual care and health technology assessment considerations

“…The questions for HTA were about the best way to implement virtual care to continue to provide healthcare during the pandemic, including implementation considerations and patient perspectives and experiences. 10 As we move forward in a post-pandemic world, HTA questions on virtual technologies adopted during the pandemic may include not just whether they work but will likely include analyses on what medical conditions would be suitable for virtual care as compared to in-person care. Other questions could investigate the value of new virtual technologies by considering relative value among other virtual technologies, value to different stakeholders (eg, health system, patients, and society), value of different modes of communication, understanding priorities around equity of access and digital security, and acceptability of different technologies.…”

“…The questions for HTA were about the best way to implement virtual care to continue to provide healthcare during the pandemic, including implementation considerations and patient perspectives and experiences. 10…”

“…Considerations associated with virtual and remote technologies across a variety of conditions in a technology agnostic approach were assessed. 10 This HTA took a unique approach and assessed how RM programs for cardiac conditions can work most effectively by conducting a realist review. The HTA also included patient perspectives and experiences review and an ethical analysis.…”