World Heart Day: How Can Digital Therapeutics Help Manage Heart Failure?
The healthcare sector, globally, has combated several pandemics and severe health complications for centuries. Ailments related to the heart are predominant and have registered a high mortality rate of up to 25-40% globally[i]. The good news is that heart related complications can be controlled, managed and even averted upto a certain extent by maintaining a healthy lifestyle. The bad news, however, is that only a fraction of people actually pay attention to the basic recommendations to lead a healthy lifestyle, a vital aspect in managing Heart failure. To add to this, late diagnosis due to lack of awareness and failure to adhere to prescribed medical programs aggravate the situation. However, with advancement in technology and developments in Digital Therapeutics (DTx) platforms, the major challenges are addressed and the work is in progress to resolve the complexities involved in the post treatment care as heart patients need continuous monitoring, real-time support and sensitive care. While heart clinics and cardiac rehab centers exist, the process to approach them is inclusive of multiple steps and is time-consuming. Right from booking an appointment, the commute, and in some cases inter-city travel and further wait time at the clinic make the visit to doctor a tedious process, often a reason for patients to skip follow-up visits. DTx has simplified the process, open channels of easy accessibility to timely and quicker guidance.
Heart Failure Management
According to Research Reports in Clinical Cardiology[ii], the gold standard of patient management in heart failure can be defined as daily activities that maintain clinical stability. The patient management requires two basic steps that are very important - early diagnosis and treatment monitoring and follow up.
Early Diagnosis: One of the major challenges in handling HF is the lack of awareness, often leading to late diagnosis. Sometimes, post-heart attack, post angioplasty or by-pass, the heart’s capacity to pump blood is reduced and this could lead to HF. As the primary symptoms for HF are breathlessness and fatigue, and these symptoms aggravate and worsen over a period of time if neglected. If the person is having diabetes, they may not notice any symptoms at all initially. It thus takes a while before patients seek a cardiologist consultation and get diagnosed. As a result, treatment is often given at a late stage leading to poor prognosis. In this scenario, Identification of symptoms and awareness of underlying disease progression could help patients in getting diagnosed at an early stage and receive timely treatment.
In 2015, the World Health Organization (WHO) started developing a project with a pilot in Lebanon for earlier detection of CVD´s[iii]. The main objectives were
The initiative to detect cardiovascular diseases early has expanded to two-thirds of the country’s Primary Health Care network’s 217 facilities, with more than 14 000 people screened through testing of BMI (body-mass index), fasting blood sugar, blood pressure and lifestyle habits, such as physical inactivity, smoking and harmful use of alcohol. Two out of every five people were at risk and subsequently referred to health centers for further tests. This initiative has not only averted any severe situation all of sudden for the patients but also reduced burden on the country’s health infrastructure. Therefore, early diagnosis is of utmost importance. Patient support platforms empower the patients, To give quicker access to a first step of diagnosis,
Treatment adherence and monitoring: Inability or ignorance to follow prescribed self-care; aggravate risk factors, increasing the incidences of hospitalization and decreasing life span. HF can be managed both medically and surgically. Adherence to treatment is extremely crucial as even slightest deviations can have severe consequences. Adherence to the treatment requires patients to monitor their symptoms, adhere to their medication, diet and exercise regimens and manage symptoms by recognising changes and responding by either adapting behaviours or by seeking appropriate assistance [iv].However, there is limited adherence to the lifestyle recommendations. Nonadherence to medications and lifestyle contributes to hospital admissions in up to one-third of patients. Efforts to reduce readmissions are of critical importance[v]. Approximately half of the non-adherence is intentional, whilst the remainder occurs because patients are either unaware that they are not taking medications as prescribed or the regimen is just too complex[vi].A patient support system which can help patients deal better with the condition could resolve the issue of negligence and failure to adhere to medication and lifestyle guidelines. Previously, with technology still evolving and penetrating the healthcare system, monitoring patients was a challenge. However, with recent developments of robust digital platforms, the communication channels between patients and healthcare systems have opened up significantly. Awareness of the personal medical history of the patient, diligent follow-ups with the patients, monitoring their health post the surgery will be simplified and aligned with the requirements of the patients.
In 2017, a report published by Journal of the practice of Cardiovascular Sciences[vii] , stated that Heart failure (HF) is a major health problem in India with a post admission mortality of 20%–30%. A big driver for this is medication adherence which ranges from 25% to 50%, and also following the guideline-based medication is low for Indian patients.
Digital tools that educate patients on, disease awareness and offer reminders to take medicines on time can help manage the disease better. Educating the patient on salt and water intake, and urine output as well as creating awareness of the symptoms such as swelling of feet.
The average age group with HF is above 60 years. People in this age group may require assistance in managing severe health complications Usually, a patient's kin often don the hat of the caregiver. Tools that integrate caregivers into the care plan, provide a holistic approach to patient management. Health coaches with scheduled telephonic conversations with the family members in a timely manner can help share the emotional burden for the family.
Usual care methods include manual monitoring, keeping a log of blood pressure, and exercise regime and following up with doctors with these reports at routine intervals. However, this is seldom followed. Prolonged gaps in-between the visits could lead to incorrect decision making. However, a digitally empowered tool, tracking vital information can help physicians make more informed treatment decisions.
Hospital systems can leverage patient support tools to enable remote patient monitoring, as Care needed by HF patients only increases with time. Extending this support from the health care industry will not only impact patient satisfaction, but also aid to achieve better patient outcomes.
As the norm goes, the care for a HF doesn't stop but increases post the treatment, hospitals and healthcare systems at large, including this feature will not just help them build their business line but also augment the trust factor with patients. Patient Support Programs need to be involved from the beginning of symptoms of heart failure, or treatment. The digital programs cover the entire spectrum and can be involved in the beginning which can prevent late diagnosis and empower the patients to adhere to medications and lifestyle guidelines. It involves the caregiver support, or emotional support to monitor blood pressure and Blood Sugar Level, encourage exercise regime and follow recommended diet.
Time and again, the experts have insisted on early diagnosis and adherence as two crucials steps to avoid severity or increase life span of HF patients, and reduce incidences of readmission in hospitals. Co-existence of support programs and traditional guidance can boost the quality of treatment.
