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COVID-19 is sparking change in how high-risk patients are cared for with remote treatments ǀ View

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Six months ago, I implanted a tiny device in the heart of Margaret McDermott from Birmingham, a 71-year-old lady with heart failure. She had recently been hospitalised for pulmonary edema (fluid in the lungs). She was selected to join a unique study where a tiny microcomputer would be implanted into her heart. This microcomputer can transmit accurate pressure readings from her heart remotely. Until now, this information was only available in a hospital setting.

I knew that having this information remotely would allow me to intervene early enough before she had symptoms and to adjust her medications. But I hadn’t appreciated the full value of this technology until the start of the COVID-19 outbreak, Margaret could not come to the hospital and I was forced to rely heavily on the remote readings from the device. Just a few days ago, I noticed that Margaret’s heart pressure had increased to levels that could cause pulmonary edema. I called her and recommended an increase in the dose of water tablets (furosemide). Over ten days, the pressure decreased to levels that do not lead to pulmonary edema. Because of this tiny device, she was able to get the best care possible without having to come to hospital and expose herself to the risks of COVID-19.

75% drop in hospitalisations

Remote patient monitoring has many values in general, but even a greater value for people who are suffering from chronic diseases. According to Statista’s research department, the remote patient monitoring market in the US in 2015 was valued at around $175 million (€159 million) and is expected to grow to almost $536 million (€486 million) by 2022. Now, with the COVID-19 pandemic, the remote monitoring market is likely to increase further.

In times with restricted movement, such as those we’re currently in, remote patient monitoring can free valuable healthcare personnel and equipment, so they can focus on fighting pandemics.
Professor Francisco Leyva-Leon
Cardiologist

In normal times, remote patient monitoring keeps the patient under supervision regardless of their location, time constraints, hospital facilities availability and caregiver’s availability. Patient convenience is always an important consideration, but when it comes to the elderly population who may have difficulties moving around, remote care is an absolute game changer. In addition, remote patient monitoring reduces the burden on the healthcare systems. It enables getting treatment early enough and as a result reduces hospitalisations as well as readmissions, which are a huge burden on healthcare systems around the world.

According to a Deloitte Center for Health Solutions’ survey, remote patient monitoring is expected to save $200 billion (€181 billion) in healthcare costs globally over the next 25 years. The remote care industry is seeing positive trends; the Roanoke-Chowan Community Health Center reports that hospital readmissions fall 75% for chronic patients that use a remote patient monitoring system.

In times with restricted movement, such as those we’re currently in, remote patient monitoring can free valuable healthcare personnel and equipment, so they can focus on fighting pandemics. Margaret’s case shows how during a pandemic lockdown, the medical staff can continue monitoring and keep chronic, high-risk patients at home, while ensuring they receive the high quality care they need.

Remote care technologies development is on the rise

The market for implantable and wearable devices which monitor vital body parameters, such as body temperature, blood pressure, pulse rate and saturation is rapidly on the rise. Some of them are targeted at the health conscious, like the Apple Watch, while others are targeted at high-risk patients like Vectorious’ V-LAP, the device fitted in Margaret’s heart. This in-heart microcomputer is a digital wireless sensor device, located on the heart’s left atrium and monitors heart failure patients daily.

It’s time we embrace more widely remote patient treatment and monitoring technologies. What was previously considered a luxury in the healthcare system, must now be implemented as the standard of care.
Professor Francisco Leyva-Leon
Cardiologist

Other interesting remote monitoring devices that can collect robust data include the Owlytics smartwatch, which was designed to continuously and automatically detect falls in the elderly population, Neoteryx Mitra Microsampling Devices, were are used to simplify blood collection for patients at home, and DexCom, which allows continuous glucose monitoring for people with diabetes, so that they need not take finger pricks for glucose testing.

A company called TytoCare has overcome some of the gaps between contactless online testing and physical examination. The system instructs the patient how to perform the test and can identify if the test was done properly and whether the doctor has the information they need. Such a system is much cheaper than an in-person meeting with a doctor and eliminates the need for frequent visits.

It’s time for a change

The COVID-19 pandemic is forcing us to a change our usual care practices and to rely on remote patient monitoring. Even when the COVID-19 crisis is over, this change is likely to bed itself in routine clinical practice. It’s time we embrace more widely remote patient treatment and monitoring technologies. What was previously considered a luxury in the healthcare system, must now be implemented as the standard of care.

  • Professor Francisco Leyva-Leon is a cardiologist at Birmingham’s Queen Elizabeth Hospital in the UK.

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