mark ledwidge - heartbeat trust
TRANSCRIPT
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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
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Agenda
» Our journey in remote patient monitoring
» Challenges and opportunities
» What does the ecosystem need
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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
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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
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Weight monitoring in HF
2 Kg over 2-3 days
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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
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Weight monitoring in HF
2 Kg over 2-3 days
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TENS-HMS
Remote Patient monitoring
TelemonitoringUsual Care
Cleland et al JACC 2005;45(10):1654–64
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Heartphone
» Collaboration
Crofton Cardiac Systems
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DAILY WEIGHT
Heartphone
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DAILY WEIGHTTRENDS ANALYSIS
Heartphone
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DAILY WEIGHTTRENDS ANALYSIS
7/7 NURSE/REGISTRAR REVIEW
CARDIOLOGIST REVIEW
Heartphone
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DAILY WEIGHTTRENDS ANALYSIS
CARDIOLOGIST REVIEW
ADDITIONAL INPUTS
Heartphone
7/7 NURSE/REGISTRAR REVIEW
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Large spread of patients
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Large spread of patients
Mr BF, West Cork
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Mr BF, West Cork
Unstable, high risk
Referrals to GP
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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
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Mr BF, West Cork
Ecosystem not primed
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Ecosystem primed
» TENS-HMS
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Ecosystem not-primed
» Tel-HF
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The hype is over
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Challenges
» Soft endpoints do not convince payers in heart failure care
» The Ecosystem needs integration
» Evidence base needs to evolve
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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
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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
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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**
**
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Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
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Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
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Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
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Opportunity - improve the algorithm
Example
Reported Symptomatic Deterioration
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Opportunity - Demographics
20101 in 1060+ yrs old
30
20501 in 5
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Opportunity – 80% of what we do
Chronic disease, mostly managed poorly
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Opportunity – 80% of what we do
Chronic disease, mostly managed poorly
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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
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Opportunity - Economics
» ‘Healthcare Unbound’, Forrester
2010 20150
5
10
15
20
25
30
35
40
Remote personal health mon-itoring
$ Bi
llion
PA
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Opportunity - multimarkers
» 5 question daily patient reported outcome
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Opportunity - multimarkers
» 5 question daily patient reported outcome » Other peripherals: BP, glucometer, pulse
Oximeter
» Improve the algorithm» Reduce workload
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Opportunity - multimarkers
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Opportunity - multimarkers
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Opportunity – this cannot continue
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Opportunity – integrated ecosystem
Patients
Government 3rd party payers
service providers,clinicians
Suppliers
Devices,Technical,Regulatory
Carers
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Patient Centred Care
“It’s not an intrusion. It’s a great feeling of security.”