Whether its assessing remote management of heart failure patients or use of mobile technologies to screen patients with atrial fibrillation (AFib), the ability of telemedicine to improve patient outcomes continues to be a focus of new research. A special Late-Breaking Science in Telemedicine session on Aug. 25 during ESC Congress 2018 featured some of the newest research in this area.

In the TIM-HF2 trial, also simultaneously published in The Lancet, researchers found that a structured remote patient management program when used in a well-defined heart failure population could reduce the percentage of days lost to unplanned hospital readmissions or all-cause death. The trial randomized 1,571 patients from hospitals and cardiology practices in Germany to either remote patient management plus usual care, or usual care only and were followed for up to 393 days.

Overall, the percentage of days lost due to unplanned hospital readmissions and all-cause death was 4.88 percent in the remote patient management group as compared with 6.64 percent in the usual care group. Broken down, patients assigned to remote management lost approximately 18 days per year compared with approximately 24 days per year for patients assigned to usual care.

"To the best of our knowledge, this is the first RCT to use a structured remote patient management intervention that was designed to be a true holistic approach for the management of patients with heart failure, involving cardiologists, general practitioners, nurses, other health-care providers, and the patient," researchers said. They noted that the concept of "a telemedical center with physicians and heart failure nurses available 24 hours a day, every day, and able to act promptly according to the individual patient risk profile" was a key factor in the success of this approach.

In a separate study, the use of a smartphone application using pulse-plethysmography (PPG) through the phone's camera proved helpful in identifying new AFib patients. Researchers involved with the DIGITAL-AF study recruited 12,328 participants via a local newspaper. Participants used their own smartphone to measure their heart rhythm twice daily and when experiencing symptoms over a nine-day period. Each measurement was automatically classified as regular rhythm, possible AFib, irregular rhythm or insufficient quality. Researchers assessed the impact of the screening program via a follow-up questionnaire four months later.

In total, 80 percent of participants (9,889) were identified with sinus rhythm, 17 percent with irregularities non-related to AFib (2,111), 2 percent without high-quality measurements (191) and 1.1 percent with AFib (136). Researchers noted the average age of the AFib-group was 62.8 ± 10.9 years, 70 percent was male. Additionally, 75 percent of AFib patients did not experience any symptoms, 28 percent had persistent AFib (all detected on first PPG measurement), and 72 percent had paroxysmal AFib. Of the 100 of the 136 AFib patients that completed the follow-up questionnaire, 53 percent consulted a medical professional to confirm diagnosis. Of the 60 patients who had been previously diagnosed with AFib, the screening resulted in 28 percent receiving adjustments to their current care strategy following consultation with their care providers.

"These results indicated a high yield of newly identified AFib patients without utilizing excessive health care resources," researchers noted. "This novel digital methodology requires future research but already demonstrates its potential as a scalable, reliable and cost-effective screening tool for AFib."

Two other trials presented as part of the ESC Congress telemedicine session – REMOTE-CIED and RM-ALONE – addressed remote monitoring as a promising method for following up with patients with cardiac electronic devices.

Keywords: ESC18, ESC Congress, Atrial Fibrillation, Flavins, Luciferases, Heart Failure

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