E-Health and Telemedicine: Current Situation and Future Challenges

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Demographic changes, progress in medicine technology and regional problems to provide health care to low density populations are posing great challenges to our health systems. Rapid progress in computer sciences and informatics technologies will have a great impact on the way health care will be delivered already in the near future. This article describes chances and challenges of e-Health and Telemedicine in the framework of our health systems and in particular of today’s cardiology services. The most promising applications of e-Health and Telemedicine include: 1. prevention and lifestyle interventions; 2. chronic disease management including hypertension, diabetes and heart failure; 3. arrhythmia detection including early detection of atrial fibrillation and tele-monitoring of devices such as pacemaker, ICD, and implantable rhythm monitoring devices; 4. tele-rehabilitation. An important challenge for those involved in these new technologies will be to keep the main focus on patient’s individual needs and to carefully evaluate the evidence behind the practice.

Authors:

Hugo Saner

Preventive Cardiology & Sports Medicine University Bern University Hospital, Switzerland

List of references:

Saner H. eHealth and telemedicine: current situation and future challenges. Eur J Prev Cardiol. 2013;20(2 Suppl):1-2.
Saner H. e-Cardiology and e-Health: from industry-driven technical progress to clinical application. Saner H. Eur J Prev Cardiol. 2014;21(2 Suppl):2-3.
McManus RJ, Mant J, Bray EP, et al. Telemonitoring and selfmanagement in the control of hypertension (TASMINH2): a randomized controlled trial. Lancet. 2010;376:163-172.
McKindtry B, Hanley J, Wild S, et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: mulitcentre randomized controlled trial. BMJ. 2013;346. doi. 10.1136/bmj.f3030.
Kaambwa B, Bryan St, Jowett S, et al. Telemonitoring and selfmanagement in the control of hypertension (TASMINH2): a cost-effectiveness analysis. Eur J Prev Cardiol. 2014;21(12):1517- 1530.
Redfern J, Thiagalingam A, Jan S, et al. Development of a set of mobile phone text messages designed for prevention of recurrent cardiovascular events. Europ J Prev Cardiol. 2014;21(4):492-499.
Cortez NG, Cohen G, Kesselheim AS. FDA Regulation and Mobile Health Technologies. NEJM. 2014;371(4):372-379.
Powell AC, Lansmann AB, Bates DW. In search of a Few Good Apps. JAMA. 2014;311(18):1851-1852.
Bruining N, Caiani E, Chronaki C, et al. Acquisition and analysis of cardiovascular signals on smartphones: potential, pitfalls and perspectives. Eur J Prev Cardiol. 2014;21(2S):4-13.
Stewarts S, Hart CL, Hole DJ, et al. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart. 2001;86:516-521.
Stewart S, Hart C, Hole DJ, et al. A population-based study of the long-term risk associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisely siudy. Am J Med. 2002;113:359-364.
Sridhar ARM, Reddy M, Maybrook R, et al. Trends in acute ischemic cerebrovascular events associated with atrial fibrillation in the last decade in the United States: time for an appraisal of progress? J Am Coll Cardiol. 2014;63:12S.
Kelly PJ. Preventing the Rise of Atrial Fibrillation-Related Stroke in Populations: A Call to Action. Circulation. 2014;130:1221-1222.
Healy JS, Roopinder K, Sandhu K. Are We Ready for Mass Screening to Detect Atrial Fibrillation? Circulation. 2015;131:2167- 2168.
Hasan A, Paul V. Telemonitoring in chronic heart failure. Eur Heart J. 2011;32:1457-1464.
Anker SD, Kohler F, Abraham WT. Telemonitoring and remote management of patients with heart failure. Lancet. 2011;378:731- 739.
Inglis SC, Clark RA, McAlister FA, et al. Which components of heart failure programs are effective? A systematic review and metaanalysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridget Cochrane Review. Eur J Heart Failure. 2011;13:1028-1040.
Kohler F, Winkler S, Schieber M, et al. Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients with Chronic heart Failure. Circulation. 2011;123(17):1873-1880.
Hindricks G., Tabarski M, Glikson M, et al. Implant based multiparameter telemonitoring of patients with heart failure (INTIME). Lancet. 2014;384(9943):583-590.
Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure : a randomized controlled trial. Lancet. 2011;377(9766):658-666.
Varma N, Ricci RP Telemedicine and cardiac implants: what is the benefit. Eur Heart J. 2013;34(25):1885-1895.
Dubner S, Auricchio A, Steinberg JS, et al. ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs). Europace. 2012;14:278-293.
Wilkoff BL, Auricchio A, Brugada J, et al. HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIEDs): description of techniques, indications, personnel, frequency and ethical considerations: developed in partnership with the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA); and in collaboration with the American College of Cardiology (ACC), the American Heart Association (AHA), the European Society of Cardiology (ESC), the Heart Failure Association of ESC (HFA), and the Heart Failure Society of America (HFSA). Endorsed by the Heart Rhythm Society, the European Heart Rhythm Association (a registered branch of the ESC), the American College of Cardiology, the American Heart Association. Europace. 2008;10:707-725.
Carlson MD, Wilkoff BL, Maisel WH, et al. Recommendations from the Heart Rhythm Society Task Force on Device Performance Policies and Guidelines Endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) and the International Coalition of Pacing and Electrophysiology Organizations (COPE). Heart Rhythm. 2006;3:1250-1273.
Maisel WH, Hauser RG, Hammill SC, et al. Recommendations from the Heart Rhythm Society Task Force on Lead Performance Policies and Guidelines: developed in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm. 2009;6:869-885.
Varma N, Michalski J, Stambler B, et al. Superiority of automatic remote monitoring compared with in-person evaluation for scheduled ICD follow-up in the TRUST trial-testing execution of the recommendations. Eur Heart J. 2014;35:1345-1352.
Heidbuchel H, Hindricks G, Broadhurst P, et al. EuroEco (European Helth Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. Eur Heart J. 2015;36:158-169.
Adamson PB, Smith AL, Abraham WT, et al. InSync III Model 8042 and Attain OTW Lead Model 4193 Clinical Trial Investigators. Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation. 2004;110:2389-2394.
Landolina M, Gasparini M, Lunati M, et al. InSync/InSync ICD Italian Registry Investigators. Heart rate variability monitored by the implanted device predicts response to CRT and long-term clinical outcome in patients with advanced heart failure. Eur J Heart Fail. 2008;10:1073-1079.
Kadhiresan VA, Pastore J, Auricchio A, et al. PATH-CHF Study Group. Pacing therapies in congestive heart failure: a novel method - the activity log index - for monitoring physical activity of patients with heart failure. Am J Cardiol. 2002;89:1435-1437.
Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. 2005;112:841-848.
Capucci A, Santini M, Padeletti L, et al. Italian AT500 Registry Investigators. Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with anti tachycardia pacemakers. J Am Coll Cardiol. 2005;46:1913-1920.
Santini M, Gasparini M, Landolina M, et al. Cardiological centers participating in ClinicalService Project. Device detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators. J Am Coll Cardiol. 2011;57:167-172.
Gunderson BD, Patel AS, Bounds CA, et al. An algorithm to predict implantable cardioverter-defibrillator lead failure. J Am Coll Cardiol. 2004;44:1898-1902.
Schoenfeld MH, Compton SJ, Mead RH, et al. Remote monitoring of implantable cardioverter defibrillators: a prospective analysis. Pacing Clin Electrophysiol. 2004;27:757-763.
Varma N, Michalski J, Stambler B, et al. Superiority of automatic remote monitoring compared with in-person evaluation for scheduled ICD follow-up in the TRUST trial-testing execution of the recommendations. Eur Heart J. 2014;35:1345-1352.
Heidbuchel H, Hindricks G, Broadhurst P, et al. EuroEco (European Helth Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. Eur Heart J 2015;36:158-169.
Mampuya WM. Cardiac rehabilitation past, present and future: An overview. Cardiovasc Diagn Ther. 2012;2:38-49.
Smith SC, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58:2432-2446.
Piepoli MF, Corra U, Benzer W, et al. Secondary prevention through cardiac rehabilitation: From knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010;17:1-17.
Huang K, Liu W, He D, et al. Telehealth interventions versus center-based cardiac rehabilitation of coronary disease: A systematic review and meta-analysis. Eur J of Prev Cardiol. 2015;22(8):959- 971.
Frederix I, Hansen D, Coninx K, et al. Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalisation rate, medical costs and quality of life: A cost-effectiveness analysis. Eur J Prev Cardiol. 2015;epub ahead of print.

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