Delivering remote monitoring, through primary care, to patients with chronic heart failure

Abstract It is estimated that over 90,000 patients in Ireland have a diagnosis of Heart Failure. The HeartCare at Home study was commenced in 2021 as a collaboration between Centric Health and Roche Diagnostic. The study aimed to examine the feasibility of implementing a remote monitoring programme for patients with heart failure, through primary care, and the impact on hospitalisations, A&E attendances, and GP visits. Patients were referred to the study by their GP. Patients were provided with a blood pressure monitor, weighing scales and smart device in line with the study protocol. The remote monitoring app, a CE-certified Medical Device Class IIa, was provided by Luscii Healthtech. Patients were requested to input their weight, blood pressure, heart rate and symptoms for two weeks after a undergoing a clinical onboard to establish a baseline. Thereafter, readings were entered by patients twice weekly. Patients participated for a minimum of 12 months. If measurements fell outside pre-determined parameters or a deterioration was noted, the team was alerted through the Luscii app dashboard. Where clinically appropriate and in line with cardiologist approved protocols, the team supported the patient to titrate their diuretic medication at home for a maximum of 3 days, with continuous daily monitoring. The patient’s GP was informed of all deteriorations and changes in the patient’s condition and of all recommendations made by the HeartCare at Home team. One hundred and sixty-two patients were onboarded to the programme while 120 patients completed one year follow up (42% female; median age 76 years, range 31-100 years). Thirty five percent of patients had a diagnosis of HFrEF, 13% HFpEF, and 6% HFmrEF while 43% were undifferentiated. Seventy five percent of patients had a NYHA I or II classification. Over 95,000 clinical measurements were recorded through the Luscii app over the course of the study. Of the decompensations managed directly by the HeartCare at Home team with medication titration and daily monitoring, 70% were clinically resolved following the HeartCare at Home protocol. Adherence to inputting monitoring data remained strong throughout the intervention period with over 89% of participating patients continuing to upload readings as scheduled at 12 months. Using established and secure communication pathways, such as HealthLink and Healthmail, the clinical team were able to interact with each patients GP to ensure continuity of care and optimised patient treatment. The HeartCare at Home study demonstrates the feasibility of implementing a remote monitoring programme through primary care. Remote monitoring with direct access to clinical support has potential benefits for patients, clinicians, and the health service at large. Further research, in a larger cohort, and examination of the cost of implementation of remote monitoring in primary care, is warranted.