Promover juntos el tratamiento de los pacientes cardíacos

Los cuidados de seguimiento han cambiado radicalmente durante las décadas en las que he participado. Sin duda, el cambio más significativo fue el desarrollo de la monitorización a distancia, que comenzó con BIOTRONIK Home Monitoring en 2001. Como resultado de este método fiable y cómodo para evaluar a distancia el dispositivo del paciente, las sociedades profesionales establecieron directrices para la frecuencia de seguimiento del dispositivo. Esto permitió que se detectaran los problemas que requerían una acción clínica y se actuara antes en consecuencia. Como resultado de un mayor seguimiento y de una atención más temprana a los problemas clínicos importantes relacionados con el dispositivo, la FDA afirma que Home Monitoring reduce la mortalidad, permite una detección temprana de problemas clínicos potencialmente significativos y factibles, así como que reduce los seguimientos presenciales.

Históricamente diría que han existido dos retos principales, pero uno de ellos ha sido superado en gran medida por BIOTRONIK Home Monitoring, y es el cumplimiento por parte del paciente. En los primeros tiempos de la monitorización a distancia, la mayoría de las empresas instruían al paciente en este tipo de monitorización en el momento del implante y luego enviaban el monitor a casa con el paciente o se lo enviaban por correo más tarde. El equipo de monitorización a distancia tenía entonces que ser «emparejado» con el paciente. Entre el olvido de las instrucciones de conexión del equipo de monitorización a distancia y los retrasos en la recepción del equipo, el cumplimiento no siempre era muy bueno, por lo que teníamos muchas lagunas de datos. Con BIOTRONIK Home Monitoring se adoptó un enfoque diferente. El paciente se llevaba su dispositivo «mensajero» de transmisión, no requería el emparejamiento y no exigía que tuviera un teléfono fijo independiente. De esta forma, se ha demostrado que el cumplimiento con BIOTRONIK Home Monitoring es superior al 90 %, en gran medida porque simplificó la implementación de la monitorización a distancia. 

Parece que eso fue hace mucho tiempo. Hoy en día, nos enfrentamos más a la cuestión de estar abrumados por los datos que a las lagunas que veíamos entonces. El principal reto que les queda a los profesionales sanitarios es la gestión de todos estos datos. Sin embargo, esto también se está haciendo más fácil y menos pesado con los nuevos sistemas que ayudan a la gestión de datos, la compatibilidad con la HCE, etc. 

The simple answer is that the role of digital health in routine patient care is rapidly increasing. Even when I left everyday clinical practice two years ago, patients were bringing or sending in rhythm tracings they had collected from their smartwatch or other commercially available tools that could collect and transmit an ECG tracing. As wearables continue to improve—and they will—the data will become increasingly relevant. Whether the data is considered ”medical grade” or not, much of the information will be clinically relevant.

When increasingly available sources of digital health data met the pandemic, the whole discipline moved forward at warp speed; much faster than it would have in the absence of the pandemic.

Depending on the quality of digital data collected and transmitted, the data will likely become a mainstay of chronic disease management. Even currently, if a patient were to transmit a tracing to their physician that they got on their smartwatch or other digital recording devices—and that tracing showed a symptomatic episode of atrial fibrillation—based on symptoms or duration of the episode, it could result in the physician initiating treatment earlier. Without the digital recording device, the patient would have needed to make an appointment, obtain monitoring equipment, and wait to see if another episode was captured while the monitoring was performed. Only then would they see their physician again and have therapies considered.

Overall, it’s a definite plus. Empowered patients and better-informed patients make both interactions and outcomes more positive. When it comes to being digitally empowered, there is a bell-shaped curve of patient “empowerment” as one would expect. There are some patients who remain very much “need to know only” and “I do whatever my doctor advises,” to the other end of the spectrum where patients want every detail they can obtain regarding their medical information. Those patients can require more time from the physician, but if the information can be appropriately distilled, packaged, and used, the end result should be a positive one.

We will see a greater benefit when we effectively get device data to the patient in an understandable way. Now that most healthcare organizations provide patient portals, we have seen a steady increase in patients accessing their data and relying on digital approaches for making appointments, renewing medications, asking simple questions, and getting telehealth diagnoses and treatment that would have otherwise required an “in-office” visit. Depending on the patient portal, some patients can view device-related information. However, the real benefit for patients will occur when we can appropriately package the data and provide it via a digital application or smartphone app. Such apps already exist, but there will be a learning curve for figuring out the optimal way of distilling and presenting that information in a way any given patient can understand. A document by Dr. Eric Topol beautifully explores how to prepare healthcare providers with education and training to deliver the digital future.

First and foremost, the industry needs to provide the necessary tools. Specifically, Home Monitoring as currently provided, allows daily transmissions of data for the patient and then distills, organizes, and provides the data to the patient via an easy to use “app” or other digital access.

Next, in order to know how to most effectively organize and provide device data to the patient—we need more collaboration between industry, the medical community, patients, and established patient advocacy organizations. A serious effort needs to be made to find out what specific information would be helpful to physicians other than those directly involved in device follow-up, because many types of physicians will have interactions with device patients other than the electrophysiologist or clinician in the device follow-up clinic. These include primary care physicians, general internists, obstetricians, hospitalists, neurologists, heart failure specialists, and more. What these physicians would like to see will depend on their type of interaction and their clinical interests. “One size” will  not “fit all,” so we will need to elicit their input as we strive to improve collaboration with industry and patients.

Thank you very much, Dr. Hayes.

Dr. Hayes’ answers show the need for adequate disease management – with and for patients and physicians. We at BIOTRONIK are dedicated to addressing physicians' challenges and advancing cardiac patient management.

Read more about our one portfolio of products and services for disease management – the BIOTRONIK CardioSphere.