SiTe iC: A telemonitoring system for heart failure patients

https://doi.org/10.1016/j.ijmedinf.2020.104204Get rights and content

Highlights

  • A telemonitoring system (SiTe iC) based on Clinical Practice Guidelines for Heart Failure management.

  • The SiTe iC system is efficient to follow-up heart failure patients.

  • The SiTe iC system improves self-care patients.

  • The SiTe iC system has the potential to prevent rehospitalizations.

Abstract

In the last years, multidisciplinary post-discharge treatment programs, such as telemonitoring, have been promoted as a strategy for Heart Failure (HF) management. However, the distinctive requirements that a telemonitoring system should have, have not been clearly identified. To this aim, the most relevant requirements for telemonitoring of HF patients are derived from evidence-based Clinical Practice Guidelines (CPGs) for HF management. The main objective of this work is to present a prototype of a telemonitoring system for HF patients, named SiTe iC, that has been developed based on the identified requirements, highlighting its design and evaluation.

A first prototype of the system was designed and programmed. It consists of an mHealth app for HF patients, a website for physicians who monitor patients, and a server which runs an Application Programming Interface to allow communication between the app and the website.

The system was thoroughly assessed through a clinical trial that demonstrates that telemonitoring using SiTe iC actually improves patients self-care when compared to usual care and it has the potential to avoid patient re-hospitalizations.

This study demonstrated that the identified functional requirements for telemonitoring systems are relevant. In addition, thanks to SiTe iC, HF patients would take a more active role in their disease management by improving self-care.

Introduction

Heart Failure (HF) is the inability of the heart to provide enough blood according to the body’s requirements [1]. It is a chronic and lifestyle-related disease that affects patients quality of life and is the leading cause of hospitalization in adults over 65 years old [2].

Delays in symptom recognition, medication and dietary noncompliance, as well as lack of knowledge and skills for competent self-management, are common reasons for re-hospitalizations of HF patients [3,4].

Several studies indicate that multidisciplinary post-discharge treatment programs, as telemonitoring systems, can avoid a large portion of HF-related readmissions and improve patients quality of life [5].

Telemonitoring is defined as the use of information and communication technology to monitor healthy individuals or chronically-ill patients remotely. The literature suggests that the most promising applications for home telemonitoring are for chronic illnesses such as HF [6].

Some telemonitoring systems use TV sets as the main device for patients [7] others use video game consoles [3,8,9] and others use Smartphones. In the latter case, telemonitoring is better referred to as Mobile Health Technology (mHealth) [10].

As Schnall et al [11] have remarked, mHealth is a promising tool for actively involving patients in their own health care because most people own and regularly use a mobile phone. For these reasons, to develop a telemonitoring system to follow-up HF patients, an mHealth application using Smartphones as the main device for patients seems to be the alternative of choice for effective management of this disease and to reach as many patients as possible. On the other hand, in different reviews of telemonitoring systems for cardiovascular patients, the authors had concluded that it is still not clear as to whether or not the existing telemonitoring systems actually improve patient condition and well-being [12]. Also, in previous works, it was recognized that further research efforts are needed to understand the causes underlying the success of telemonitoring as a key driver to improve health conditions of chronically-ill patients [13]. More specifically, telemonitoring systems have been developed based on different functionalities and monitor different parameters, since the minimal set of functional requirements that an HF monitoring system should deploy have not been identified yet. However, there are many evidence-based Clinical Practice Guidelines (CPGs) of the most relevant cardiology associations about HF management. CPGs are statements that include recommendations intended to optimize patient care that are based on a systematic review of evidence and an assessment of the benefits and harms of alternative care options [14]. Besides, as Kang and Park [15] have highlighted, these CPGs need to be converted into a computer-interpretable guideline for the development of an mHealth app that provides tailored information and recommendations on lifestyle management based on facts and evidence. Therefore, the main objective of this work is to present a prototype of a telemonitoring system for HF patients, named SiTe iC, that has been developed using widely accepted CPGs, highlighting its design, prototyping and validation. The proposed prototype has an mHealth app as a core component.

Section snippets

Related Work

There are different types of telemonitoring systems for HF patients, but generally, they have a main device in the patient's home through which some parameter measurements are collected and transmitted (via a telephone line or the Internet) to a platform in the hospital or some healthcare agency through which physicians can see their patients' measurements.

In general, as shown in Table 1, the systems monitor various clinical parameters, such as weight, blood pressure (BP), heart rate (HR), etc.

Requirements elicitation

An update of a previous review of CPGs about HF was carried out by the authors [22]. Only papers that are related to telemonitoring or about the remote follow-up of HF patients were included in the review. 34 CPGs [[23], [24], [25], [26], [27], [28], [29], [30], [31]] were selected and analyzed in order to assess the recommendations from the specialists on HF telemonitoring systems, such as functionalities to deploy and parameters to monitor.

As shown in Table 2, most of the cardiology

Results

A non-invasive telemonitoring system (SiTe iC) was designed and implemented as a prototype. It provides an mHealth application for the HF patients, a monitoring platform for the professionals and a Server to allow communication between both platforms and the data storage. The functionalities of the system are presented in the use-case diagram of Fig. 6.

Both patients and professionals have functionalities to create a user account, sign up, log into the system, edit their personal data and handle

Discussion

The positive results of the evaluation of the Site iC system confirmed that telemonitoring systems do improve HF management. In particular, the presented telemonitoring system has the added value of complying with all the recommendations of the CPGs, that is, its design is based on scientific evidence and sound practices. Also, it is important to note that few studies show the intervention characteristics of the systems used in the HF management, but in the review by Maric et al [16] only 20%

Conclusions

This article presents a system for the follow-up of HF patients, the requirements that this type of systems must fulfill and the results of its evaluation in a clinical trial. The functional requirements that have been included in the prototype design of the system (SiTe iC) were extracted from a systematic and thorough analysis of the known CPGs. The system was evaluated through a clinical trial with real patients that demonstrates that it makes a statistically significant difference for

Authors' contributions

All authors equally contributed to the article named “SiTe iC: a telemonitoring system for heart failure patients”.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Summary Table

  • Several studies indicate that multidisciplinary post-discharge treatment programs, as telemonitoring systems, can avoid a large portion of HF readmissions and improve HF patients quality of life.

  • The different type of telemonitoring interventions in the different trials avoid comparing the interventions among them to establish which is indeed the best

CRediT authorship contribution statement

Lucía María Yanicelli: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Writing - review & editing, Visualization, Project administration. Marcela Vegetti: Conceptualization, Methodology, Writing - review & editing, Visualization. Carla Belén Goy: Conceptualization, Formal analysis. Ernesto Carlos Martínez: Conceptualization, Methodology, Writing - review & editing. Myriam Cristina Herrera: Conceptualization, Resources.

Declaration of Competing Interest

The authors declare that there is no conflict of interests regarding the publication of this article.

Acknowledgement

We thank physicians from the Zenón Santillán Health Center Hospital for their assistance during the clinical trial.

References (41)

  • J. Finkelstein et al.

    Feasibility of congestive heart failure telemanagement using a wii-based telecare platform

  • R.E. Perna et al.

    Revisión de insuficiencia cardíaca en Argentina avances y retrocesos luego de dos décadas de registros y más de 19000 pacientes incluidos

    Insuficiencia cardíaca

    (2015)
  • S.C. Inglis et al.

    Structured telephone support or non-invasive telemonitoring for patients with heart failure

    Cochrane Database Syst. Rev.

    (2016)
  • S. Meystre

    The current state of telemonitoring: a comment on the literature

    Telemed. J. E-health

    (2005)
  • J. Finkelstein et al.

    Implementing home telemanagement of congestive heart failure using xbox gaming platform

  • J. Finkelstein et al.

    Introducing home telemanagement of congestive heart failure using xbox gaming platform

  • L.S. Evangelista et al.

    Examining the effects of remote monitoring systems on activation, self-care, and quality of life in older patients with chronic heart failure

    J. Cardiovasc. Nurs.

    (2015)
  • S.C. Inglis et al.

    Which components of heart failure programmes are effective? A systematic review and meta‐analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane Review

    Eur. J. Heart Fail.

    (2011)
  • R. Purcell et al.

    Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews

    BMC Fam. Pract.

    (2014)
  • Institute of Medicine
  • View full text