Establishment of a Monitoring Clinic Based on Wearables for Patients with Heart Failure

AUTHORS

Sajad Yarahmadi ORCID 1 , 2 , * , Mohammad Gholami ORCID 2 , Tayebeh Cheraghian ORCID 3

1 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran

2 School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

3 Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran

How to Cite: Yarahmadi S, Gholami M, Cheraghian T . Establishment of a Monitoring Clinic Based on Wearables for Patients with Heart Failure, J Arch Mil Med. Online ahead of Print ; In Press(In Press):e110456. doi: 10.5812/jamm.110456.

ARTICLE INFORMATION

Journal of Archives in Military Medicine: In Press (In Press); e110456
Published Online: November 16, 2020
Article Type: Letter
Received: October 20, 2020
Accepted: October 29, 2020
Uncorrected Proof scheduled for 8 (3)
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1. Activity Level Measurement

The use of a step counter is increasing. The device has an accelerometer (FitbitTM) and measures the amount of movement and converts it to the amount of physical activity according to an algorithm. There are many commercial devices in this vein. Exercise and activity can reduce the risk of hospitalization in patients with heart failure (5), and the use of wearable devices to monitor physical activity by registering and encouraging patients to be more active can facilitate this goal (Figure 1). One study found that people who used these devices increased the number of steps per day from 5,899 to 7,890 (6). Another study showed that 60 minutes of physical activity per day in patients with congestive heart failure reduced the risk of mortality by 35% (7).

2. Heart Rate Monitoring

These devices are usually attached to the wrist and control heart rate using photolithography (PPG). Using a light-emitting diode, the device illuminates a capillary substrate and thus detects ECG changes (such as pulse oximeters). In a study that compared the accuracy of these devices, four models of these devices were compared with ECGs. The results showed that with a difference of 20% per minute, these devices were similar to ECGs (8).

3. Blood Pressure Monitoring

High blood pressure is one of the causes of heart failure. Heart failure and its treatments are reasons for hypotension (4). Blood pressure measurements may be done at home or the clinic once a day, but the use of blood pressure monitor watches (OmronTM HeartGuide) can do this several times a day and monitor the patient continuously.

4. Diagnosis of Arrhythmias

One of the most common cardiac arrhythmias in patients with congestive heart failure is atrial fibrillation (9). Following the diagnosis of this arrhythmia, the use of anticoagulants is strongly recommended (10). Deformation in PPG waves can indicate an irregular pulse. Traditional patient monitoring requires a HOLTER to diagnose arrhythmias, but recently FDA-approved wearable chips (Carnation patchTM and VivaLNK) can be used to monitor patients for several days, making it easier to use these devices. They can be used for a longer time than HOLTER. Some smartwatches (AppleTM watch and the VerilyTM Study watch) have electrodes that can record ECG. One electrode is placed under the watch to be in contact with the skin, and the other electrode is in the crown part of the watch. When the person touches the crown with the other hand, several ECG leads are generated.

5. Monitoring Response to Treatment

Checking the heart rate and blood pressure following the use of various drugs can help patients in drug titration. Monitoring activity levels can be a tool for assessing response to treatment. One study found that patients with heart failure who consumed isosorbide had lower levels of activity (11).

6. Evaluation of Symptoms and Prognosis of the Disease

Assessing the activity capacity of patients with heart failure is inversely related to the stage of the disease so that patients with the upper class of the disease are less able to perform an activity (12). The classification of the heart failure class is subjective, and there is a big difference between the diagnoses of different clinicians. Thus, using these devices to more objectively assess the level of activity and help diagnose the degree of the disease can be helpful.

7. Early Detection And prevention of Irreparable Damage

Hospitalization is costly for patients and the treatment system, and preventing readmission can greatly reduce the costs. Monitoring pulmonary artery pressure and heart rate through implants in the thoracic cavity is very helpful in identifying the onset of risk. The use of wearable devices is a non-invasive alternative to these devices that can quickly detect pulmonary congestion by examining the impedance inside the chest. Intrathoracic impedance correlates well with body fluid levels (13). One study showed the use of these devices with a sensitivity of 87% and a specificity of 70% on 106 patients diagnosed with heart failure (14). In a study, to prevent errors in diagnosis, devices were performed to check several parameters such as ECG and intrathoracic impedance and perform accelerometry on 100 patients, which showed 70% specificity and 87% sensitivity in 10 days before onset, which is actually a high sensitivity for that time (15). An FDA-approved patch (ZOLL µCorTM) is used for the early detection of heart failure using radiofrequency waves and ECG monitoring.

8. Conclusions

Devices for measuring blood pressure, ECG, heart rate, and arterial oxygen saturation are currently available on the market for consumers. These devices must be safe and secure, and the output information must be valid for health workers. Providing devices with low error rates and valid information is usually expensive and may not be usable for most patients. Also, the information obtained from the equipment needs to be interpreted so that the results can change the patient care and treatment program at any time. Therefore, establishing clinics that have the above-mentioned equipment in such a way that this equipment can send information can be a great help to patients with heart failure. Remote monitoring of patients, in addition to reducing hospitalization costs and face-to-face visits to clinics, can also enhance the quality of life and provide comfort for patients with congestive heart failure. Also, due to the COVID-19 disease epidemic, patients may be less inclined to be physically present in medical centers, which can be a risk factor for these patients. Therefore, the establishment of a remote monitoring clinic for patients with congestive heart failure can reduce these problems. Besides, instead of purchasing the devices by patients, these devices should be purchased for a clinic and be provided to patients based on their needs. In addition to reducing the financial burden on patients and the treatment system, jobs can be created for medical graduates.

Footnotes

References

  • 1.

    Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137-46. doi: 10.1136/hrt.2003.025270. [PubMed: 17699180]. [PubMed Central: PMC1955040].

  • 2.

    Maggioni AP, Dahlstrom U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J, et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15(7):808-17. doi: 10.1093/eurjhf/hft050. [PubMed: 23537547].

  • 3.

    Abraham WT, Stevenson LW, Bourge RC, Lindenfeld JA, Bauman JG, Adamson PB, et al. Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet. 2016;387(10017):453-61. doi: 10.1016/S0140-6736(15)00723-0. [PubMed: 26560249].

  • 4.

    Singhal A, Cowie MR. The Role of Wearables in Heart Failure. Curr Heart Fail Rep. 2020;17(4):125-32. doi: 10.1007/s11897-020-00467-x. [PubMed: 32494944]. [PubMed Central: PMC7343723].

  • 5.

    Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;(4). CD003331. doi: 10.1002/14651858.CD003331.pub4. [PubMed: 24771460]. [PubMed Central: PMC6485909].

  • 6.

    Thorup C, Hansen J, Gronkjaer M, Andreasen JJ, Nielsen G, Sorensen EE, et al. Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial. J Med Internet Res. 2016;18(4). e69. doi: 10.2196/jmir.5191. [PubMed: 27044310]. [PubMed Central: PMC4835668].

  • 7.

    Loprinzi PD. The effects of free-living physical activity on mortality after congestive heart failure diagnosis. Int J Cardiol. 2016;203:598-9. doi: 10.1016/j.ijcard.2015.11.017. [PubMed: 26574935].

  • 8.

    Cadmus-Bertram L, Gangnon R, Wirkus EJ, Thraen-Borowski KM, Gorzelitz-Liebhauser J. Accuracy of Heart Rate Monitoring by Some Wrist-Worn Activity Trackers. Ann Intern Med. 2017;167(8):607-8. doi: 10.7326/L17-0380. [PubMed: 29049770].

  • 9.

    Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation. 2009;119(18):2516-25. doi: 10.1161/CIRCULATIONAHA.108.821306. [PubMed: 19433768].

  • 10.

    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200. doi: 10.1093/eurheartj/ehw128. [PubMed: 27206819].

  • 11.

    Redfield MM, Anstrom KJ, Levine JA, Koepp GA, Borlaug BA, Chen HH, et al. Isosorbide Mononitrate in Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2015;373(24):2314-24. doi: 10.1056/NEJMoa1510774. [PubMed: 26549714]. [PubMed Central: PMC4712067].

  • 12.

    Baril JF, Bromberg S, Moayedi Y, Taati B, Manlhiot C, Ross HJ, et al. Use of Free-Living Step Count Monitoring for Heart Failure Functional Classification: Validation Study. JMIR Cardio. 2019;3(1). e12122. doi: 10.2196/12122. [PubMed: 31758777]. [PubMed Central: PMC6834224].

  • 13.

    Gastelurrutia P, Cuba-Gyllensten I, Lupon J, Zamora E, Llibre C, Caballero A, et al. Wearable vest for pulmonary congestion tracking and prognosis in heart failure: A pilot study. Int J Cardiol. 2016;215:77-9. doi: 10.1016/j.ijcard.2016.04.024. [PubMed: 27111163].

  • 14.

    Darling CE, Dovancescu S, Saczynski JS, Riistama J, Sert Kuniyoshi F, Rock J, et al. Bioimpedance-Based Heart Failure Deterioration Prediction Using a Prototype Fluid Accumulation Vest-Mobile Phone Dyad: An Observational Study. JMIR Cardio. 2017;1(1). e1. doi: 10.2196/cardio.6057. [PubMed: 31758769]. [PubMed Central: PMC6832026].

  • 15.

    Stehlik J, Schmalfuss C, Bozkurt B, Nativi-Nicolau J, Wohlfahrt P, Wegerich S, et al. Continuous Wearable Monitoring Analytics Predict Heart Failure Hospitalization: The LINK-HF Multicenter Study. Circ Heart Fail. 2020;13(3). e006513. doi: 10.1161/CIRCHEARTFAILURE.119.006513. [PubMed: 32093506].

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