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STSI Touts mHealth for Cardiovascular Care Management at Home

The Scripps Translational Science Institute reports that a connected care platform that includes an mHealth app and clinical grade wearables can help providers improve care management for patients with cardiovascular issues.

Source: ThinkStock

By Eric Wicklund

- A connected care platform using clinical grade wearables and an mHealth app can accurately measure cardiovascular “vital signs” at home, according to new research from the Scripps Translational Science Institute (STSI).

In fact, researchers said, a home-based remote patient monitoring platform may be better for care management and clinical outcomes than clinic-based treatment because the data tracked and analyzed comes from the user’s normal environment, rather than a closed setting.

Researchers at the San Diego-based health system say the study, using a custom-made mHealth app and mobile health devices developed by Withings, matches the quality of information produced in previous studies conducted in a clinic.

“Cardiovascular disease remains the leading cause of death and disease worldwide,” the researchers point out in their abstract. “As demands on an already resource-constrained healthcare system intensify, disease prevention in the future will likely depend on out-of-office monitoring of cardiovascular risk factors. Mobile health tracking devices that can track blood pressure and heart rate, in addition to new cardiac vital signs, such as physical activity level and pulse wave velocity (PWV), offer a promising solution.”

The 17-week study, tracking some 211 patients, was recently published in the journal Hypertension.

Among the findings was that nearly three-quarters of those participating were able to provide continuous data for at least 14 out of the 17 weeks; this told researchers that the process wasn’t difficult and that participants enjoyed it enough to keep on doing it.

“Identifying new ways of monitoring cardiovascular risk factors is critical to reducing the burden of this disease and strains on healthcare systems across the globe,” Brian Modena, an assistant professor of Molecular Medicine at Scripps Research, clinical researcher at STSI and principal investigator for the study, said in an STSI press release accompanying the report.

“Our study combined multiple health tracking devices to holistically assess cardiovascular risk factors outside of the clinical setting along with demographics, medication adherence and stress levels,” he added. “These measurements were found to closely match national averages or prior studies performed in very controlled clinical settings, supporting their accuracy and reliability.”  

While traditional cardiovascular health studies have focused on vital signs like blood pressure, weight and heart rate, the development of newer and more accurate mobile health technologies has enabled researchers to expand their toolkit. The STSI study, for instance, collected data on sleep duration, physical activity levels, PWV (a measure of arterial wall stiffness) and various lifestyle risk factors that also influence or predict cardiovascular outcomes.

The study highlights the challenges that have faced healthcare providers in developing RPM programs that go beyond the oft-cited lack of reimbursement. Because most studies have seen high dropout rates, STSI included a monetary reward for continued participation for at least four months, a tactic that might not be viable for many providers or for scaling up such a program.

Researchers also noted the difference between consumer-facing devices and smart devices developed for healthcare providers or with connected care platforms in mind. Consumer products like fitness wearables, they noted, can fail unexpectedly or report inaccurate data, making it difficult for providers to gather enough reliable information for use in clinical decision-making.

Yet another challenge may actually favor home-based monitoring. The STSI researchers noted that “a significant amount of the variation” reported in blood pressure and PWV readings couldn’t be explained by another lifestyle factors measured.

“It is likely that factors not easily measured, such as current emotional state or technique differences, acted together influence BP recordings, perhaps with incalculable results,” the study reported. “This finding underscores the need for high periodicity of measurements, something that can likely only be done using out-of-office technologies, before making medical treatment decisions.”

Taken as a whole, the STSI research points to a promising future for connected care platforms in the home as a means of care management for cardiovascular issues, provided the technology used is reliable.

“With high adherence, satisfaction and participant engagement, this proof-of-concept study required minimal study personnel and no participant training, thereby making it likely scalable to much larger populations,” Steven Steinhubl, STSI’s director of digital medicine and senior author on the study, concluded in the press release.


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