Sensors, Wearables and Remote Monitoring Help Provide Integrated Cardiology Care
Presenter: Ami Bhatt, MD, of Massachusetts General Hospital, Boston, MA
New wearables and remote monitoring in cardiology provide the promise for better integrated care to improve both clinical practice and patients’ quality of life.
Clinical cardiology practice today includes asynchronous communications, such as patient-reported outcome measures and electronic communications; blended care of in-person and virtual synchronous visits; clinical remote monitoring and medical-grade devices; and digital tracking through wearables and social data.
“Clinical remote monitoring was first performed by cardiologists. Digital wearables are not far behind. We need more analysis of data to provide ideal care,” said presenter Ami Bhatt, MD, of Massachusetts General Hospital, Boston, MA.
Wearable devices have a wide range of potential clinical applications, including screening for atrial fibrillation, hypertension, obstructive sleep apnea, heart failure, and cardiovascular fitness. As the use of wearable devices grows, clinicians need a multifaceted approach to integrate these technologies effectively and safely into routine clinical practice. Currently, there are many devices that each have their own platform. “We want to move in the direction of one platform that is easier to use,” said Bhatt.
The focus for asynchronous solutions should include better data standards and governance, as well as data security and privacy, and limits on data overload and clinician administration burden. “Patients want this 100%. They have given a clear signal they would like to be privy to data. They want us to make it concise and helpful,” said Bhatt. “Their prime complaint is ‘Don’t just give me the data, interpret it for me.’”
Bhatt noted a National Heart, Lung, and Blood Institute grant for $37 million to study whether the Apple Watch can be used as part of a strategy to decrease anticoagulant use for atrial fibrillation and protect from cerebrovascular accident while decreasing adverse bleeding risk. The 7-year study will include 5,400 patients who will receive standard care for atrial fibrillation with chronic lifelong anticoagulation versus intermittent Apple Watch-directed treatment for “at-risk” periods.
“Technology is moving at a fast pace. We need real-world evidence that wearables will have an impact on what we are monitoring so we can implement therapy. We need to create more information from patients when they are most vulnerable,” said Bhatt.
The field of wearables is growing. Technologies now in development include EKG monitoring and arrhythmia detection, physiologic monitoring via a variety of sensors, remote monitoring systems for cardiovascular-focused conditions, and digital stethoscopes, point-of-care ultrasound, and peripheral artery disease monitoring.
Reimbursement for remote monitoring now includes physiologic monitoring, self-measured blood pressure monitoring, and continuous glucose monitoring. “We need to tell insurance companies we use monitoring in cardiology practice and we deserve to be paid for it,” said Bhatt.
Bhatt emphasized the importance of collaborative intelligence, which she defined as the use of advanced analytics and computing power with an understanding that we are responsible for both the data it is offered and fair interpretation of its outputs, with the intention of together becoming more intelligent. “Collaborate intelligence is excellent for pattern recognition. We need scientific rigor behind the data gathered through computing power, but we also need to maintain clinical autonomy to know whether what the computer gives us is right.”
References
Kumar S, Victoria-Castro AM, Melchinger H, et al. Wearables in cardiovascular disease. J Cardiovasc Transl Res 2022; Sep 9. doi: 10.1007/s12265-022-10314-0. Epub ahead of print. PMID: 36085432.
Bhatt A, Bae J. Innovating health care | the rise of collaborative intelligence: how do we instill trust in a nonhuman ‘brain’? Cardiology 2022; 51(6):30-31. https://www.acc.org/latest-in-cardiology/articles/2022/05/01/01/42/innovating-health-care-the-rise-of-collaborative-intelligence-how-do-we-instill-trust-in-a-nonhuman-brain
Bhatt A. Asynchronous care: sensors, wearables and remote monitoring. Presented at American College of Cardiology Annual Scientific Session & Expo Together With World Congress of Cardiology, March 4, 2023, New Orleans, LA. Presentation Number: 627-09.
Disclosures
Nothing to disclose