Technology moves arrhythmia management into patient-centered, home-based care
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The use of technology for the detection and management of arrhythmias has become a major focus in clinical care.
These technologies, which include watches, patches, smartphone applications and telehealth, have recently played a bigger role in not only improving care, but also empowering patients in the management of their conditions. Remote monitoring can also be performed for patients with devices such as pacemakers, implantable cardioverter-defibrillators or loop recorders.
The Apple Heart Study, which was published in The New England Journal of Medicine in 2019, serves as a strong foundation for the use of technology — specifically an Apple Watch, a telehealth visit and an ECG patch — to detect arrhythmias.
“These technologies allow patients to measure more on their own like heart rate, EKG and physical activity levels,” Seth S. Martin, MD, MHS, director of the advanced lipid disorders program of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and associate professor of medicine at Johns Hopkins University School of Medicine, told Healio. “It’s easier now for patients to measure key metrics at home and share these with their care team.”
This technology has also provided a better experience for cardiologists and other healthcare providers.
“As a cardiologist specializing in arrhythmias, being able to monitor heart rhythms continuously with the patient at home has allowed us to provide far better care for our patients,” John D. Day, MD, FACC, FHRS, cardiologist and medical director of Intermountain Heart Rhythm Specialists at Intermountain Heart Institute in Salt Lake City and past president of the Heart Rhythm Society, told Healio.
Potential challenges
Despite its advantages, this technology has some challenges, including a potential detriment to the patient-clinician relationship with fewer face-to-face visits.
There are also remaining issues regarding the technology itself. Currently an Android-equivalent of an Apple Watch is not available, for example. Android devices also need a HIPAA-compliant feature similar to FaceTime on Apple devices for video visits. Patients with Android devices often use Google Duo, which requires an additional application before their telehealth visit.
Access to this information can also be a source of obsession.
“I have had two patients who had to return their Apple Watches because it made them neurotic by constantly watching their rhythm in real time all day long wondering and worrying if they might go out of rhythm,” Day said.
Physicians are using telehealth has been more for arrhythmia management, especially during the COVID-19 pandemic. Through these appointments, cardiologists can obtain more information on relevant symptoms including palpitations, shortness of breath, fatigue and chest pain. Blood and imaging tests would still need to be performed in an office setting.
Some smartphone apps work in conjunction with wearable technology including watches and portable ECG monitors and can be used to track whether a patient stays in sinus rhythm.
“If you have a high-quality EKG recording from these devices, cardiologists specializing in arrhythmias can make an accurate diagnosis,” Day said. “However, the computer algorithms on these devices need to get better to help patients better make the diagnosis at home without having to upload their EKG recordings to their arrhythmia cardiologists.”
Day said that there are also free smartphone apps that use a camera to make an arrhythmia diagnosis, although the accuracy of those apps is substantially decreased.
Although smartphone apps predominantly focus on the detection of arrhythmias, more development and research are needed in the management of these patients.
“I’m very hopeful from the smartphone app side of things, we can bring this all together to enhance the full patient journey, from diagnosis to management,” Martin said. “We need to get this to the point that there’s strong evidence that can be published in top journals, that can be adopted by guidelines, that can be reimbursed by payers to make this a reality.”
Improved quality of life, access to care
The use of technology in the detection and management of patients with arrhythmias can also improve quality of life.
“Putting the power in the individual, finding their own personal inspiration, the feeling of control over their condition, over their environment, that can improve someone’s quality of life, to feel like they’re back in control,” Martin said. “It’s a mental thing, but it’s also a physical thing. ... When you’re healthier, you feel better, you have a better quality of life.”
Beyond improved outcomes and management of arrhythmias, using technology can also make an impact on access to equitable healthcare.
“Telehealth is now here to stay with the COVID-19 situation,” Day said. “Hopefully, the payers will continue to cover telehealth treatment even after the virus crisis has passed. As long as patients have a way to record EKGs at home, then people living in remote areas can enjoy the same level of high-quality care as people living next door to the hospital.”
Several issues would also need to be addressed including access to broadband and the devices themselves. This is an issue that Martin and his colleagues are focusing on in the American Heart Association Center for Health Technology and Innovation, which will use mobile technologies to promote equity in CV health. Several solutions would be assessed including loaning technology and providing cellular plans.
“If we don’t purposefully create solutions to promote equity to give people access, then we face this digital divide where we have some folks benefitting, others being left behind and worsening health inequities that already exist in our country,” Martin said. “That’s a critical challenge that we’re going to have to face.”
Reference:
For more information:
John D. Day, MD, FACC, FHRS, can be reached at johndaymd@gmail.com; Twitter: @drjohndaymd.
Seth S. Martin, MD, MHS, can be reached at smart100@jhmi.edu; Twitter: @sethshaymartin.
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