Bhatia Ankit, Maddox Thomas M
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, MO, USA.
Int J Heart Fail. 2020 Nov 30;3(1):31-50. doi: 10.36628/ijhf.2020.0023. eCollection 2021 Jan.
Despite clinical advances in its treatment, heart failure (HF) is associated with significant adverse clinical outcomes and is among the greatest drivers of healthcare utilization. Outpatient management of HF remains suboptimal, with gaps in the provision of evidence-based therapies, and difficulties in predicting and managing clinical decompensation. Remote patient monitoring (RPM) has the potential to address these issues, and thus has been of increasing interest to HF clinicians and health systems. Economic incentives, including increasing RPM reimbursement and HF readmission penalties, are also spurring increased interest in RPM. This review establishes a framework for evaluating RPM based on its various components: 1) patient data collection, 2) data transmission, analysis, and presentation, and 3) care team review and clinical action. The existing evidence regarding RPM in HF management is also reviewed. Based on the data, we identify RPM features associated with clinical efficacy and describe emerging digital tools that have the promise of addressing current needs.
尽管心力衰竭(HF)的治疗在临床上取得了进展,但其仍与显著的不良临床结局相关,并且是医疗资源利用的最大驱动因素之一。HF的门诊管理仍不理想,在提供循证治疗方面存在差距,且在预测和管理临床失代偿方面存在困难。远程患者监测(RPM)有潜力解决这些问题,因此越来越受到HF临床医生和卫生系统的关注。包括提高RPM报销额度和HF再入院处罚在内的经济激励措施,也在激发对RPM的更多兴趣。本综述基于RPM的各个组成部分建立了一个评估框架:1)患者数据收集,2)数据传输、分析和呈现,以及3)护理团队审查和临床行动。同时还综述了关于RPM在HF管理中的现有证据。基于这些数据,我们确定了与临床疗效相关的RPM特征,并描述了有望满足当前需求的新兴数字工具。