Some time back Dr Donal Bailey and his colleagues at Centric Health began to consider how chronic disease management might be improved in their patients. One chronic disease which had an unmet need was Heart Failure. At least 90,000 people in Ireland are living with heart failure1 with a further 160,000 living with the condition but without symptoms. Around 10,000 new patients are identified each year2. Caring for this large group of patients is a challenge for health systems across the world and Ireland is no exception.
Donal began to develop a potential solution to this challenge and identified that use of a digital tool to enable patients to be monitored remotely and interventions to be made in a timely way could improve patient management.
"While developing our care delivery model for Heart Failure, we designed it with the patient at the centre at all times to ensure it would be as convenient and reassuring as possible. We knew it must provide excellent outcomes, equitable access, and must integrate into existing care provided by the patient’s GP and Cardiologist. The Heartcare@Home remote monitoring programme is designed to monitor, support, appropriately intervene, and improve the quality of life of patients with Heart Failure throughout Ireland from the comfort of their own homes. We are privileged to be able to extend our care to our patients wherever they are.” Donal Bailey, Innovation manager at Centric Health
During 2019 Donal connected with me and my colleagues at Roche UK & Ireland and we began to explore how we could collaborate to bring the concept to a practical implementation and study. Luckily I had the expertise of my Colleagues in Digital Health innovation at Roche Diagnostics International in Switzerland to draw on and Jochen Hurlebaus and Eva Schitter. The team identified and evaluated a digital tools which enables vitals tracking (blood pressure & weight) remotely with automatically generated alerts allowing nurses focus on the patients with the highest need for care. Centric established a clinical team to monitor and manage participants in the programme. This dedicated team monitor and respond to any signs of heart failure exacerbation ensuring immediate adjustment of a patient’s medication and close follow up and monitoring of the patient’s response to treatment. The programme ultimately aims to facilitate collaborative and integrative patient centred care between the patient, their GP and their hospital team while supporting and encouraging self-management of their heart failure in a safe yet innovative manner. Centric places special emphasis on patient education, providing one to one on boarding to ensure the participant can use the app and equipment appropriately and building patient education modules into the app.
As the world knows, Covid-19 appeared and this slowed down progress but all involved worked throughout lockdowns to set up the study and begin recruiting patients towards the end of 2020. Since the COVID-19 pandemic struck Ireland it has had an impact on routine services across healthcare 3. Cardiac care is no exception 4,5,6. Patients with cardiovascular diseases are also at high risk of morbidity from COVID-19 6,7. The Heartcare@Home solution is perfectly suited to care during the pandemic as support is provided remotely by healthcare professionals with face to face consultations only required in rare cases. It is also hypothesised that by providing immediate response to a change in a patients clinical signs of heart failure deterioration, we can reduce GP and hospital attendances- an important consideration in today’s environment.
As well as supporting patients with a heart failure diagnosis, the study also hopes to examine the patient diagnosis pathway and ensure patients have the correct classified diagnosis. The symptoms of heart failure are quite common (e.g. shortness of breath, fatigue, weight gain) and effective triage to echocardiography is required 9. A blood test is available, ntProBNP, which can help with this decision and effectively rule out heart failure and ensure the correct patients are referred for echocardiogram and a full diagnosis. This test and its use is explained in the ICGPs “Heart failure in General practice guideline” 8.
In late 2020, Heartcare@Home joined the HSE Living Labs programme9, which is operated by Martin Curley and the HSE Digital Transformation team (https://hsedigitaltransformation.ie/). This programme is a structured process to support and develop innovative solutions in the healthcare system and as we reach the 100 patient landmark we hope now to take the next step in the living labs programme.
This year, Aoife Coughlan assumed the project leadership role at Centric Health and together with all the Heartcare@home team has driven the patient recruitment process and collection of outcome data (based on the ICHOM standard set for heart failure).
‘Initial data suggests patients who required titration due to a deterioration in their clinical symptoms were treated quicker and on the immediate recognition of a change in clinical status, with none requiring GP or hospital attendance following titration. Feedback from participants to date has been very positive and encouraging. Many have acknowledged the comfort of having a clinical team continuously monitoring their clinical signs and knowing there is someone to identify, advise and support them when their clinical signs change or deteriorate. In today’s challenging environment and ongoing pressures on the health system, being able to support patients to manage their heart failure more effectively at home has significant benefits for patients and doctors alike’. Aoife Coughlan, Project Leader Centric health.
Some of the anonymous feedback from patients includes:
‘The nurses have a heart and beam kindness. I think it’s a great app’
‘Thank you very much for taking such good care of us’
‘I am finding it Brilliant’
‘I find it very helpful when you know someone is there for you when you feel you may need them’
‘The availability of this app has dramatically improved the care process for patients. Thank you’
Heartcare@home is an ambitious project which aims to recruit at least 600 patients and measure the impact of this intervention on patients and healthcare budget. The study is focused on generating value based outcomes and clinical improvement in these patients, which are reliable and can inform use of solutions such as this in the real world.
John Glynn, Healthcare Development Manager, Roche Diagnostics Ireland & UK
@JohnglyBMS and linkedin.com/in/johngl75
- Moran D, Buckley A, Daly K, et al. Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study. International Journal of Cardiology 2014; 177(2):380-84.
- Minister for Health and Children 2010. Changing Cardiovascular Health 2010 – 2019. National Cardiovascular Health Policy 2010.
- https://www.rte.ie/news/health/2021/0323/1205595-ireland-health-services/ Accessed May 2021
- Casey, L., Khan, N. & Healy, D.G. The impact of the COVID-19 pandemic on cardiac surgery and transplant services in Ireland’s National Centre. Ir J Med Sci 190, 13–17 (2021). https://doi.org/10.1007/s11845-020-02292-6
- Kennelly, Brendan et al. “The COVID-19 pandemic in Ireland: An overview of the health service and economic policy response.” Health policy and technology vol. 9,4 (2020): 419-429. doi:10.1016/j.hlpt.2020.08.021
- https://irishheart.ie/news/meps-call-for-action-to-limit-effect-of-pandemic-on-cardiovascular-health/ Accessed May 2021
- https://irishheart.ie/news/patients-with-severe-heart-disease-must-be-prioritised-for-covid-19-vaccination/ Accessed May 2021
- McDonald K & Gallagher J (2019) Heart failure in General Practice. ICGP Quality and Safety in Practice Committee. https://www.icgp.ie/go/library/catalogue/item/B64C3EE3-54C9-422B-ADE05252BDE0756E/ Accessed May 2021
- https://www.hse.ie/eng/services/news/media/pressrel/digital-health-living-labs-accelerate-healthcare-solutions.html Accessed May 2021