Researchers at the UCLA Wireless Health Institute and the UCLA School of Nursing found a small but statistically significant reductions in abnormal readings of weight and blood pressure among elderly patients who had access to wireless, mobile monitors and regular feedback from physicians. They reported their findings in the Journal of Medical Systems.
Using a UCLA-developed system called WANDA (Weight and Activity with Blood Pressure Monitoring), the researchers were able to reduce the frequency of readings outside an acceptable range for weight and blood pressure by 5.6%. Participants had to have been hospitalized for a CHF-related illness within 30 days of enrollment in the study, and all were at least 65 years old.
That may not sound like a big improvement, but the UCLA team said even a reduction of 5.6% could have a major impact on patient quality of life and healthcare spending.
CHF is the leading cause of death in the U.S., killing 282,754 people in 2006 alone, according to Centers for Disease Control and Prevention statistics cited in the article. About 670,000 people in the U.S. are diagnosed with CHF every year, and the disease is responsible for $29 billion in annual medical expenses, the study said. In Europe, 24% of hospitalized CHF patients reportedly are readmitted within 12 weeks of discharge.
"Experts and researchers in cardiac medicine suggest monitoring and tracking patients' symptoms on an everyday basis in order to prevent emergencies," the paper said. "However, patients often lack the motivation to exercise and/or monitor their own health related measurements. Hence, a remote health monitoring system with medical oversight should serve useful for observing patients with CHF.
In addition, remote health monitoring systems are extremely cost effective due to the availability of inexpensive monitoring devices and infrastructure."
This study stands in stark contrast to earlier research that relied on antiquated technology such as faxing and on workflow shortcomings. That approach did not allow clinicians to make timely interventions and help modify unhealthy behaviors, the UCLA team said. In particular, a much-maligned 2010 article in the New England Journal of Medicine dismissed the potential of "telemonitoring" even though that study asked patients to phone in their readings regularly. After six months, only 55% of patients even bothered to report as often as three times a week.
"In order to design an effective remote health monitoring system for CHF, it is important to make an automated real-time system for checking important values such as weight, blood pressure, heart rate, daily activity, and symptom responses. A system must send a reminder to patients to reduce gaps in the dataset. In addition, the system should be in real-time to ensure the timely delivery of data to physicians," the UCLA study said.
The UCLA Wireless Health Institute and the nursing school designed WANDA on three tiers of technology. Sensors monitor patient health, take relevant measurements, and transmit readings to the second tier, made up of Web servers to store and analyze data. The third tier is a database server for backup and recovery purposes.
They built two versions of the first tier, one for elderly and less-technically proficient patients that sends data over standard phone lines and a second, mobile version that works with Apple's iPhone and the Android smartphone operating system, to transmit data to the server via Wi-Fi or 3G cellular networks.
WANDA takes measurements of weight, blood pressure, heart rate, and physical activity, and incorporates the heart failure somatic awareness scale (HFSAS), which tracks measures 12 metrics related to awareness of CHF symptoms. These include elevated heart rate, chest pains, swollen feet, and shortness of breath. Should anything be abnormal or should users simply fail to take the necessary readings, the automated system sends a text message to help get patients back on track.
"Wireless health technologies, including pervasive sensors and wireless communications, can potentially help CHF patients through daily monitoring along with guidance and feedback," the study concludes. "Patients who have cardiovascular system disorders can measure their weight, blood pressure, activity, and other health related measurements by using wireless health applications whenever and wherever they need to. A wireless health system gives real-time and computer-based analysis, reducing the need for specialist visits. This remote real-time care prevents emergency situations and alerts caregivers when they must help patients."
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