Awareness of chronic disease technologies and remote monitoring among not only the medical community but the general population has continued to increase dramatically, as evidenced by the recent New York Times article about implantable defibrillators ability to remotely track heart failure patients. News coverage of these devices, which are poised to significantly improve quality of life for the 6 million people in the U.S. who suffer from HF, emphasizes the shift toward patient- and consumer-focused care and highlight's the public's increasing involvement in self-managing their health to a greater extent. In the Pipeline, we've covered numerous different developments in remote monitoring, which can all be found here.
For more information about remote monitoring, continue reading after the jump, or contact me at WynnP@advisory.com to discuss how Tech Insights is tracking these devices and their effect on EP and HF strategy.
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The ACC's Door to Balloon (D2B) initiative helped establish the concept "time is muscle," showing that early intervention for patients suffering a heart attack can significantly improve outcomes. Despite huge improvements in the hospital efficiencies in treating heart attack patients, however, individuals often wait too long to seek medical attention. A new implantable device presented this Wednesday at the 33rd annual scientific sessions for the Society for Cardiovascular Angiography and Interventions (SCAI) could help close the gap between symptom onset and medical attention by providing a clear alert to the patient that he or she is suffering a heart attack.
Angel Medical Systems' AngelMed Guardian is about the size of a pacemaker and is implanted into the chest and connected to a lead that is attached to the heart. The lead provides electrogram measurements that are constantly compared to a stored copy of the patient's normal electrogram. Any potentially dangerous shift in ST segment causes a series of alerts--the device itself buzzes inside the patient's chest, and an external hand-held telemetry device beeps and flashing LEDs.
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The remote monitoring of EP devices has grown considerably in recent years. Today, hundreds of thousands of patients are implanted with cardiac rhythm management (CRM) devices that are capable of being monitored remotely (i.e., outside of a device clinic). The operational advantages of remote monitoring are obvious and easily demonstrated: a remote device-check takes less than half the time as an in-office check and eliminates 50 to 75 percent of clinic visits for routine check-ups. For these reasons, electrophysiologists have been quick to adopt the technology.
With the operational advantages well-understood, physicians are now trying to determine the clinical advantages of the technology. Today in Atlanta, Dr. George Crossley presented findings from the Clinical Evaluation Of Remote Notification to Reduce Time to Clinical Decision (CONNECT) trial. The trial used a wireless remote monitoring and notification system available through Medtronic's Conexus-enabled ICDs and CRT-Ds and compared its use to standard in-person clinic visits. The study showed that remote monitoring with automatic notification cut the time to clinical decision making by nearly two-thirds.
The largest randomized, prospective study designed to quantify the advantages of remote monitoring with automatic notifications, CONNECT followed nearly two thousand ICD and CRT-D patients at 136 sites in the United States. Data from the study showed a sizeable reduction in the time between the onset of an arrhythmic problem and a clinical decision on how to manage it (an average of 29.5 days in the standard-care group vs. 10.5 days in the remote-monitoring group). There was also a reduction in length of stay (LOS) for remote-monitored patients that had to be hospitalized, which Dr. Crossley estimated resulted in hospital savings of approximately one million dollars.
One interesting aspect of the remote-monitoring data was the gap in time between a notification and a clinical decision, which could be as long as 4 to 5 days. Dr. Crossley suggested this may show a 'Laissez-Faire' attitude among physicians to respond to data, but it may also reflect that the data does not carry an imperative for immediate action. We often hear complaints about data overload, a complaint that will only grow as more and more devices start transmitting an endless stream of bits and bytes. Could it be that the speed of data transmission may have out-paced its clinical need?
This article in The Economist really caught my eye this morning. Some pharmaceutical companies are beginning to bridge the gap between drugs and technology with so-called "smart pills" that are able to relay feedback after being swallowed. Once one of these pills hits the stomach, the acids activate the communication technology to send wireless signals through the body to another chip embedded in the skin. The skin patch can then wirelessly upload data to a smart phone or an internet site for physicians. Physicians can use the data to track whether the patient is taking the right meds at the right time and may also potentially track adverse reactions.
The Economist notes that some major pharmaceutical companies, like Novartis through their purchase of the start-up Proteus Biomedical, are pursuing this strategy to make up for the fact that many lucrative drugs have patents about to expire.
While this technology certainly is interesting by itself, I think it speaks volumes to where health care is headed. I've blogged a lot recently about how remote monitoring is beginning to play a larger role in the care of patients with chronic disease. While in TI our research focuses more on biotech than on pharmaceuticals, we do of course often track how advances in pharma may impact hospital-based business. As chronic disease management is often greatly concerned with adherence (or lack thereof) to pharmaceutical protocols, these "smart" pills may one day play a large role in the continuing management of these patients. There are obviously concerns, though, with a "big brother" type mentality associated with watching patient adherence to medical protocols. The article has a lot of interesting perspectives--I'd encourage anyone with a few extra minutes to read it.
Good morning! I recently came across an article about a remote monitoring pilot taking place in the UK. As hospitals continue to look for cost savings opportunities amidst recession and reform, some are considering how new technologies like remote monitoring can reduce readmissions and lower the cost of providing care at home to patients with chronic diseases like diabetes and heart failure. I thought this article was particularly interesting as it highlights one of the largest pilot projects to date using the technology.
In England, even the NHS has recognized the need to do more with less and manage chronic disease more effectively over time. Philips, long known for their big budget diagnostic equipment like CT scanners, is hoping their Telehealth Solutions can prove to the NHS that their system is a cost effective way of managing chronically ill patients. As the US continues to look for ways to reduce readmissions and better manage these patients, these data will likely become extremely important for our health care system, as well.
For more information on how TI can help with telemedicine and remote monitoring strategy for chronic disease management, please contact me at WynnP@advisory.com. And continue reading for more detail on the pilot itself.
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