By Wai Hong Wilson Tang, MD, as told to Hallie Levine
While we’ve come a long way in the treatment and management of heart failure, we can still do better. By 2030, over 8 million adults will be living with heart failure, a 50% increase compared to almost 2 decades earlier. We need to do everything we can to give these people what they need to thrive after their diagnosis.
That’s where digital health and technologies come in. There’s good research now to show that it can help both doctors and patients manage heart failure and improve life with the condition. Here’s what I think is the most promising.
Remote monitoring. While this has been available now for the last several years, it really got put to use during the COVID-19 pandemic, when many people with heart failure chose to isolate at home to protect themselves. Normally, we monitor a patient’s heart activity with a Holter monitor, a device that’s applied and fitted in the doctor’s office. This allows us to check that the person’s treatment plan is working. But that became harder to do during the pandemic. Instead, we often turned to a device known as a Zio patch, a small water-resistant patch that’s attached to the chest, which providers could ship directly to patients. They put it on for 2 weeks, then returned it to the company so that their heart data could be analyzed.
Implantable devices. We can now take remote monitoring a step further and implant devices that can track your heart health at home. One new one is the CardioMEMS HF System. This is a tiny pressure-sensing gadget that a doctor inserts into your pulmonary artery during surgery. You then use a home electronics unit to take daily pulmonary artery pressure readings at home, and that data goes to your heart failure medical team to review. One study known as the CHAMPION trial found that using these sorts of implantable devices reduces heart failure hospitalizations by 28%. It makes sense: If your doctor can get your pulmonary artery pressure under control, then this should prevent your heart failure from worsening.
Various apps. Both Apple and Fitbit have ECG-like apps you can use to check your heart’s rhythm. (An electrocardiogram, or ECG, is a test usually done in your doctor’s office that measures the electrical activity of your heart.) They can pick up an irregular heartbeat, or an increased heart rate, which can help you diagnose and treat your heart failure. Just the other day, I met with a new heart failure patient who told me she was diagnosed after her Apple watch noticed her heart rate was going sky high. Thankfully, her disease was caught in the early stages. But without it, she might not have been diagnosed until much later because she didn’t have any other symptoms of heart failure like feeling breathless, swelling of ankles or legs, or exhaustion.
Apps can also help you manage the day-to-day aspects of your life. One app, Health Failure Storylines, developed by the Heart Failure Society of America, allows you to record daily vitals like weight, blood pressure, and heart rate, as well as medication, physical activity, and even your mood. It also has a symptom tracker, which can be helpful to figure out how well a medication is working, as well as if it’s causing any side effects.
Text messages. An important part of heart failure management is making sure you take your meds regularly, eat a healthy diet, and exercise regularly. This is where text check-ins from your doctor or treatment center can be helpful. One small study of 60 people with heart failure found that enrolling them in a text reminder program, along with a remote blood pressure and weight monitoring program, made them 50% less likely to end up hospitalized. Other research shows that text messages improve medication adherence in all sorts of diseases, including heart disease.
The bottom line? Studies show that these sorts of technologies and programs can reduce your chances of being admitted to a hospital or of dying from heart failure. But while they are all useful, they can’t replace that in-person visit with your doctor. There’s still the need for a careful balancing act between electronic and human contact. When we see patients face to face, we’re able to really build rapport, something we can’t always do over a text or the internet. But used together, they have the potential to truly revolutionize patient care.