Use of eHealth in the management of pulmonary arterial hypertension: review of the literature

Abstract

BackgroundPulmonary arterial hypertension (PAH) is a severe chronic condition associated with poor quality of life and high risks of mortality and hospitalisation. The utilisation of novel diagnostic technologies has improved survival rates although the effectiveness of Electronic Health (eHealth) interventions in patients with a chronic cardiopulmonary disease remains controversial. As the effectiveness of eHealth can be established by specific evaluation for different chronic health conditions, the aim of this study was to explore and summarise the utilisation of eHealth in PAH.MethodWe searched PubMed, CINAHL and Embase for all studies reporting clinical trials on eHealth solutions for the management of PAH. No limitations in terms of study design or date of publication were imposed.Results18 studies (6 peer-reviewed journal papers and 12 conference papers) were identified. Seven studies addressed the accuracy, safety or reliability of eHealth technologies such as intra-arterial haemodynamic monitoring of the pulmonary artery pressure, self-administered 6-Minute walk test App, computerised step-pulse oximeter and ambulatory impedance cardiography. Two studies evaluated eHealth as part of the medical management and showed a reduction in hospitalisation rate.ConclusionsThe evidence of eHealth supporting the management of people with PAH is limited and only embraced through a few studies of small sample size and short-term duration. Given the proposed clinical benefits in heart failure, we postulate that the evaluation of eHealth for the clinical management of PAH is highly warranted.

Evaluation of a digital health system (PAHcare™) for routine care of patients with pulmonary arterial hypertension: The CBS-PAH study protocol

“…The adoption of eHealth technologies has shown to be useful regarding strategies aimed at monitoring patients with PAH ( 11 ). However, the interventions reported to date were mainly focused on remote disease monitoring using devices such as a digital pedometer, real-time wireless monitoring of heart rate, cardiac index and cardiac output, 6-min walk home test applications, step oximetry linked to a computer, or an implantable hemodynamic monitor of drug-induced variations in positive airway pressure ( 11 ).…”

“…However, the interventions reported to date were mainly focused on remote disease monitoring using devices such as a digital pedometer, real-time wireless monitoring of heart rate, cardiac index and cardiac output, 6-min walk home test applications, step oximetry linked to a computer, or an implantable hemodynamic monitor of drug-induced variations in positive airway pressure ( 11 ). Besides, in most cases, these devices were not integrated into the patient's medical management, and none of the studies assessed the impact of the intervention in important clinical outcomes such as changes in HCPs visits, mortality, hospitalizations, and none evaluated its impact on HRQoL ( 11 ). The CBS-PAH clinical investigation described herein seeks to evaluate the acceptability and usefulness of the PAHcare™ digital platform to reduce PAH burden, including patients' emotional wellbeing.…”

“…In the particular case of PAH, a recent review of the literature evaluating the use of eHealth strategies found that they were safe, accurate, and reliable, contributing to the clinical management of PAH patients ( 11 ). However, only in two of the studies, the strategy was part of the medical management, and most participants pertained to World Health Organization (WHO) classification Group 2 (post-capillary PAH), which has completely different health management needs than the WHO Group 1 PH (pre-capillary PAH) ( 11 ). Lastly, none of the studies assessed the impact of eHealth strategies on the patient's HRQoL ( 11 ).…”

“…However, only in two of the studies, the strategy was part of the medical management, and most participants pertained to World Health Organization (WHO) classification Group 2 (post-capillary PAH), which has completely different health management needs than the WHO Group 1 PH (pre-capillary PAH) ( 11 ). Lastly, none of the studies assessed the impact of eHealth strategies on the patient's HRQoL ( 11 ).…”

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

“…et al combining the results of 18 studies (6 peer-reviewed journal papers and 12 conference papers). To date, the evidence supporting the use of the electronic health (eHealth) in the management of PAH patients is still limited to few studies of small sample-size but further imminent investigations, encouraged by the current pandemic, could contribute to spread telemedicine in this field [ 39 ].…”