Remote Patient Monitoring of Heart Failure patients in Rural Hawkes Bay

Spritely’s remote patient monitoring platform reduces the time it takes to up-titrate medication from 41 weeks to 16 weeks, significantly reducing patient risk and healthcare costs.

The heart’s job is to pump blood and oxygen around the body and deliver waste products (carbon dioxide) back to the lungs to be removed. When it fails to do this job adequately, we call it heart failure.

Heat Failure

The causes of heart failure are myriad, but usually it develops slowly and gets progressively worse. It often develops after other conditions (such as hypertension) have weakened or damaged the heart. Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions.

Most patients with HF are elderly, constituting up to 80% of patients suffering from this disease with both incidence and prevalence of the condition increasing with age. A large study published in 2021 showed that of more than 5M people admitted to hospital with a single primary HF diagnosis, the mean age was 72.1 years.

People who get admitted to hospital with HF are not usually discharged quickly. Studies have shown that patients stay around 4 days on average, and if symptoms worsen, the average stay is 17 days.

Discharge and recovery

Recovering from HF can be a long road and is not without risk. Some studies have suggested that only 50% of people diagnosed with congestive heart failure over the age of 75 will survive for 5 years. The 10 year survival rate for all-type heart failure is 35%.

Patients are particularly at risk of hospital readmission in the period immediately following discharge, when specialist HF nurses titrate medication to stabilise the heart’s function and return it to a safe level of performance. Over 40% of adults in this study of 3,006 participants with a mean age of 81.5 years were readmitted within 180 days.

Up-titrating medication

Up-titration of heart failure medicines is a precise and careful process. Every patient is different and as such they require accurate monitoring to ensure the right level of medication is being prescribed at the right time. The process can take several months and is particularly time-consuming when patients live in geographically isolated areas.

In rural Hawkes Bay, for example, it typically takes 10 months to up-titrate heart failure patients. Rural clinics are arranged in Wairoa, but these are limited to a maximum of 10 patients. With just one nurse practitioner flying in from Napier on a fortnightly basis, patients can go for weeks without being seen by a clinician.

Remote patient monitoring

Spritely can be incredibly helpful for some patients recovering from heart failure. Not just better for patients either, it is better for clinicians and there is no shortage of evidence to support this. The main benefits are discussed below.
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• Reduces Patient Risk
  Spritely enables rapid up-titration of heart failure medicines. Clinicians have increased confidence because patients can be seen more often and there is more data to support decision making. Rapid up-titration can be achieved safely, tolerably and effectively with an intensive treatment strategy. This has been has been proven to reduce mortality and morbidity.
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• Minimises health costs
  Costs associated with heart failure include frequent hospital admissions and when things deteriorate longer stays in hospital. Remote monitoring provides closer clinical oversight, which enables earlier intervention. This can reduce readmission rates and minimise length of stay at hospital. This article from the American Heart Association is an excellent statement on the importance improving access to remote care, especially for older people.
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• Improves workforce capacity
  Up-titrating medicines for heart failure patients can be a time-consuming exercise. Especially if the patient lives rurally or has difficulty attending clinic appointments. The flexibility of remote monitoring means patients can take readings, send messages, get reminders and attend video consultations when it is most convenient for them. This increases compliance with treatment plans and adherence to their medication regimen. Clinicians also save a lot of time by travelling less and reducing non-attendance. This can improve patient ratios by enabling a single clinician to manage more patients.
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• Addresses equity issues
  Equity issues arise when some parts of the population have difficulty accessing the healthcare they need. RPM helps to address this by providing rural populations with care, which is as good or better than patients located near hospitals. This is also helpful for patients that have limited mobility, poor access to transport, are in financial hardship or have responsibilities that make attending appointments difficult.

In summary

Spritely’s RPM platform has been proven to be effective across a number of specialties including cardiology where it is used for the management of heart failure patients who live in rural areas. Not only is it effective, it is also extremely efficient. This is important when considering the overall value that RPM contributes. One reason for this is that patients find it to be very engaging. That’s because Spritely supports multiple ways of connecting with patients (both synchronously and asynchronously). This supports a comprehensive “wrap-around” model of care that goes way beyond just recording health vitals. The system also helps to support equitable outcomes for those people who have worse access to healthcare than others, ensuring that the service they receive is just as good as anyone else, or even better.

Effective, efficient, engaging, equitable. This is the future of care closer to home.

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