Mark Ledwidge - Heartbeat Trust

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Mark Ledwidge - Heartbeat Trust

  1. 1. HeartPhone – positioning remote patient monitoring in Heart Failure ecosystem<br />Dr. Mark Ledwidge, Research Director, Heart Failure Unit, St Vincent’s University Hospital<br />Sept 16th, 2011<br />
  2. 2. Agenda<br />Our journey in remote patient monitoring<br />Challenges and opportunities<br />What does the ecosystem need<br />
  3. 3. Heart Failure – Ideal for remote patient monitoring<br />1-2% of population, high readmission rates, many are preventable<br />Hospitalisation rates for heart failure 1971-2000 (NHLBI) age stratified rates US<br />
  4. 4. Manual Remote Patient Monitoring<br />50<br />45<br />40<br />35<br />30<br />RC<br />25<br />Event Rate (%)<br />MC<br />20<br />15<br />10<br />5<br />0<br />Rich '93<br />Rich '95<br />Stewart '99<br />McDonald 02<br />Components – outbound calls from trained healthcare professional, home weight monitoring<br />
  5. 5. Weight monitoring in HF<br />2 Kg over 2-3 days<br />
  6. 6. Weight monitoring in HF<br />2 Kg over 2-3 days<br /><ul><li>Only 20% sensitive
  7. 7. Non adherence > 30-50%
  8. 8. Assumes all patients are the same
  9. 9. Most weight gains are too subtle</li></li></ul><li>Weight monitoring in HF<br />2 Kg over 2-3 days<br />
  10. 10. TENS-HMS<br />Remote Patient monitoring<br />Telemonitoring<br />Usual Care<br />Cleland et al JACC 2005;45(10):1654–64<br />
  11. 11. Heartphone<br />Collaboration<br />Crofton <br />Cardiac <br />Systems<br />
  12. 12. DAILY WEIGHT<br />Heartphone<br />
  13. 13. DAILY WEIGHT<br />TRENDS ANALYSIS<br />Heartphone<br />
  14. 14. 7/7 NURSE/REGISTRAR REVIEW<br />DAILY WEIGHT<br />CARDIOLOGIST REVIEW<br />TRENDS ANALYSIS<br />Heartphone<br />
  15. 15. ADDITIONAL <br />INPUTS<br />7/7 NURSE/REGISTRAR REVIEW<br />DAILY WEIGHT<br />CARDIOLOGIST REVIEW<br />TRENDS ANALYSIS<br />Heartphone<br />
  16. 16. Large spread of patients<br />
  17. 17. Large spread of patients<br />Mr BF, West Cork<br />
  18. 18. Mr BF, West Cork<br />Unstable, high risk<br />Referrals to GP<br />
  19. 19. Mr BF, West Cork<br />Unstable, high risk<br />Referrals to GP<br />Multiple GP referrals to hospital, no heart failure unit in CUH, 6 months echo waiting list, diagnostic BNP unavailable<br />Compliance <50%, confidence reduced<br />
  20. 20. Mr BF, West Cork<br />Ecosystem not primed <br />
  21. 21. Ecosystem primed<br />TENS-HMS<br />
  22. 22. Ecosystem not-primed<br />Tel-HF<br />
  23. 23. The hype is over<br />
  24. 24. Challenges<br />Soft endpoints do not convince payers in heart failure care<br />The Ecosystem needs integration<br />Evidence base needs to evolve<br />
  25. 25. Opportunity - improve the algorithm<br />Better sensitivity<br />Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions<br />
  26. 26. Opportunity - improve the algorithm<br />Better sensitivity<br />Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions<br />
  27. 27. Opportunity - improve the algorithm<br />Better sensitivity<br />**<br />**<br />**P<0.001<br />Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions<br />
  28. 28. Opportunity - improve the algorithm<br />Example<br />Reported Symptomatic Deterioration<br />
  29. 29. Opportunity - improve the algorithm<br />Example<br />Reported Symptomatic Deterioration<br />
  30. 30. Opportunity - improve the algorithm<br />Example<br />Reported Symptomatic Deterioration<br />
  31. 31. Opportunity - improve the algorithm<br />Example<br />Reported Symptomatic Deterioration<br />
  32. 32. Opportunity - Demographics<br />2010<br />1 in 10<br />60+ yrs old<br />30<br /> 2050<br />1 in 5<br />
  33. 33. Opportunity – 80% of what we do<br />Chronic disease, mostly managed poorly<br />
  34. 34. Opportunity – 80% of what we do<br />Chronic disease, mostly managed poorly<br />
  35. 35. Opportunity - Economics<br />
  36. 36. Opportunity - Economics<br />‘Healthcare Unbound’, Forrester<br />
  37. 37. Opportunity - multimarkers<br />5 question daily patient reported outcome <br />
  38. 38. Opportunity - multimarkers<br />5 question daily patient reported outcome <br />Other peripherals: BP, glucometer, pulse Oximeter<br />Improve the algorithm<br />Reduce workload<br />
  39. 39. Opportunity - multimarkers<br />
  40. 40. Opportunity - multimarkers<br />
  41. 41. Opportunity – this cannot continue<br />
  42. 42.
  43. 43. Opportunity – integrated ecosystem<br />Government <br />3rd party payers<br />Devices,<br />Technical,<br />Regulatory<br />service providers,<br />clinicians<br />Patients<br />Suppliers<br />Carers<br />
  44. 44. Patient Centred Care<br />“It’s not an intrusion. <br />It’s a great feeling of security.”<br />

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