By Wai Hong Wilson Tang, MD, as told to Hallie Levine
Although we have 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 from nearly 2 decades earlier. We need to do everything we can to give these people what they need to thrive after diagnosis.
That’s where digital health and technology come in. There is now good research showing that it can help both doctors and patients manage heart failure and improve quality of life with the disease. Here is what I think is most promising.
Remote monitoring. While this has been available for the past few years, it really came into play during the COVID-19 pandemic, when many people with heart failure chose to self-isolate at home to protect themselves. We usually monitor a patient’s heart activity with a Holter monitor, a device that is fitted and placed in the doctor’s office. This allows us to check if the person’s treatment plan is working. But it became more difficult to do during the pandemic. Instead, we often turned to a device called the Zio patch, a small waterproof patch that is attached to the chest, which providers could send directly to patients. They put it on for 2 weeks, then returned it to the company so their heart data could be analyzed.
Implantable devices. We can now take remote monitoring a step further and implant devices that can monitor your heart health at home. One new feature is the CardioMEMS HF system. This is a tiny pressure-sensing device that a doctor places in your pulmonary artery during surgery. You then use home electronics to take a daily pulmonary pressure reading at home, and this data goes to a heart failure doctor for review. One study called the CHAMPION study found that using these types of implantable devices reduces heart failure hospitalizations by 28%. It makes sense: If your doctor can get your pulmonary artery pressure under control, this should prevent your heart failure from getting worse.
Various apps. Both Apple and Fitbit have EKG-like apps you can use to check your heart rate. (An electrocardiogram, or electrocardiogram, is a test usually done in the doctor’s office that measures the electrical activity of the 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 a new heart failure patient who told me she was diagnosed after her Apple Watch noticed her heart rate skyrocketing. Fortunately, each disease was caught in its early stages. But without that, she might not have been diagnosed until much later because she had no other symptoms of heart failure, such as shortness of breath, swelling in her ankles or legs, or fatigue.
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, lets you record daily vitals like weight, blood pressure, and heart rate, as well as medications, exercise, and even your mood. It also has symptom tracking, which can be helpful in finding out how well a drug is working, as well as whether it’s causing side effects.
Text message. An important part of managing heart failure is making sure you take your medications regularly, eat a healthy diet, and exercise regularly. This is where a text check-in from your doctor or treatment center can be helpful. One small study of 60 people with heart failure found that enrolling in a text reminder program, combined with remote blood pressure and weight monitoring, made them 50% less likely to be hospitalized. Other studies show that text messaging improves medication adherence for a variety of conditions, including heart disease.
The point? Research shows that this type of technology and apps can reduce your chances of being hospitalized or dying from heart failure. But while they’re all helpful, they can’t replace that in-person visit with your doctor. A careful balancing act between electronic and human communication is still required. When we see patients face-to-face, we can build a relationship, something we can’t always do over text or the internet. But used together, they have the potential to revolutionize patient care.