HeartPhone – positioning remote patient monitoring in Heart Failure ecosystem Dr. Mark Ledwidge, Research Director, Heart Failure Unit, St Vincent’s University HospitalSept 16th, 2011

Agenda

» Our journey in remote patient monitoring

» Challenges and opportunities

» What does the ecosystem need

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

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

Weight monitoring in HF

2 Kg over 2-3 days

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

Weight monitoring in HF

2 Kg over 2-3 days

TENS-HMS

Remote Patient monitoring

TelemonitoringUsual Care

Cleland et al JACC 2005;45(10):1654–64

Heartphone

» Collaboration

Crofton Cardiac Systems

DAILY WEIGHT

Heartphone

DAILY WEIGHTTRENDS ANALYSIS

Heartphone

DAILY WEIGHTTRENDS ANALYSIS

7/7 NURSE/REGISTRAR REVIEW

CARDIOLOGIST REVIEW

Heartphone

DAILY WEIGHTTRENDS ANALYSIS

CARDIOLOGIST REVIEW

ADDITIONAL INPUTS

Heartphone

7/7 NURSE/REGISTRAR REVIEW

Large spread of patients

Large spread of patients

Mr BF, West Cork

Mr BF, West Cork

Unstable, high risk

Referrals to GP

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

Mr BF, West Cork

Ecosystem not primed

Ecosystem primed

» TENS-HMS

Ecosystem not-primed

» Tel-HF

The hype is over

Challenges

» Soft endpoints do not convince payers in heart failure care

» The Ecosystem needs integration

» Evidence base needs to evolve

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

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

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**

**

Opportunity - improve the algorithm

Example

Reported Symptomatic Deterioration

Opportunity - improve the algorithm

Example

Reported Symptomatic Deterioration

Opportunity - improve the algorithm

Example

Reported Symptomatic Deterioration

Opportunity - improve the algorithm

Example

Reported Symptomatic Deterioration

Opportunity - Demographics

20101 in 1060+ yrs old

30

20501 in 5

Opportunity – 80% of what we do

Chronic disease, mostly managed poorly

Opportunity – 80% of what we do

Chronic disease, mostly managed poorly

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

Opportunity - Economics

» ‘Healthcare Unbound’, Forrester

2010 20150

5

10

15

20

25

30

35

40

Remote personal health mon-itoring

$ Bi

llion

PA

Opportunity - multimarkers

» 5 question daily patient reported outcome

Opportunity - multimarkers

» 5 question daily patient reported outcome » Other peripherals: BP, glucometer, pulse

Oximeter

» Improve the algorithm» Reduce workload

Opportunity - multimarkers

Opportunity - multimarkers

Opportunity – this cannot continue

Opportunity – integrated ecosystem

Patients

Government 3rd party payers

service providers,clinicians

Suppliers

Devices,Technical,Regulatory

Carers

Patient Centred Care

“It’s not an intrusion. It’s a great feeling of security.”