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1/25/2016 Objectives HeartFailure:Trends inTechnology • Describe current technology that is available for CHF patients • Describe how current technology can benefit the CHF patient and reduce hospitalizations Amy Cruser, ACNS‐BC, MSN, APRN, RN, CHFN FinancialDisclosure • I have no financial disclosures • I will be talking about a variety of devices from specific companies but do not endorse any of them HeartFailure HeartFailure • About 5.8 million people in the United States have heart failure • One in 9 deaths in 2009 included heart failure as a contributing cause • About half of people who develop heart failure die within 5 p p p years of diagnosis • Heart failure costs the nation an estimated $32 billion each year. This total includes the cost of health care services, medications to treat heart failure, and missed days of work. • 17 billion Medicare expenditure • 37.2 billion dollars /yearly HospitalizationsforHeart Failure 1 1/25/2016 DischargeDisposition Readmissions • > 50% of patients admitted for CHF will be readmitted in 6 months with CHF diagnosis • Medicare recipients: 27 % are readmitted in 30 days (37% of these are for CHF) • 30% readmission rate for 60‐90 days after previous 30% readmission rate for 60 90 days after previous admission • 2009 Medicare started reporting readmission rates • 2010 Patient Protection and Affordable Care Act started implementing financial penalties for hospitals with high readmissions rates for 30 day readmissions Summary • “Researchers have long considered CHF to be an ambulatory care sensitive condition (ACSC). Hospitalizations of patients with ACSCs could often be avoided if these patients received timely and appropriate medical care in outpatient settings. Numerous disease management, coordination of care, and other programs have been in place to decrease preventable or avoidable hospitalizations by improving access to care and the quality of this care” Latitude– RemoteMonitoring • Boston Scientific • Device (Biv/ICD/PPM) – not all have capability • Scale, blood pressure, heart rate, RR, activity, AF burden • Daily entrees get sent to central database for nurse to review • Individual Alerts can be set up to notify provider Tele/RemoteMonitoring • Benefits: • 1. produces accurate and reliable data • 2. empowers patients • 3. influences their attitudes and behaviors 3 influences their attitudes and behaviors • 4. potentially improves their medical conditions • Further Research needed to determine: 1. clinical effects 2. cost effectiveness 3. impacts on services utilization 4. acceptance by health care providers Latitude– RemoteMonitoring • Weight Alert: 3 pounds overnight or 5 pounds in a week • Need to have active phone line or cellular adaptor • Must log onto Latitude website to get alerts • Boston Scientific will call with alerts as well 2 1/25/2016 Wireless Communication/Wanded Communicator PushButtonWireless Communicator/TouchScreen Merlin– RemoteMonitoring Merlin– RemoteMonitoring • St. Jude • Scheduled transmissions or daily alerts • Need telephone line, cellular adaptor or broadband service broadband service • Automatically monitor device while sleeping next to transmitter • Individual alerts to email or cellphone • Customize alerts CareLink – RemoteMonitoring CareLink– RemoteMonitoring • Medtronic • Provider has 24/7 access to site • For PPM, ICD, CRT‐D, CRT‐P, and insertable cardiac monitoring (Loop recorder, Reveal LINQ) • Monitor is connected to a phone line or has cellular M i i d h li h ll l capabilities • ICD’s and LinQ loop recorders are set up to automatically send in data while the patient sleeps • Individual alert notifications • Scheduled transmissions or event transmissions 3 1/25/2016 CardioSight– Remote Monitoring CardioSight – Remote Monitoring • Medtronic • Part of CareLink Network • ICDs, CRT‐D, and insertable cardiac monitors • Gives you a HF Management report or Cardiac Gives you a HF Management report or Cardiac Compass report (activity, HRs trending, optivol level, impedance, day and night HR variation, AF burden) • Quick in gathering date from patient transmission to receiving data • One touch operation Cardiocom– Remote Monitoring Cardiocom– Remote Monitoring • Telehealth nursing • Integrated nurse services • Administer KCQOL andSF‐12 • Information sent over phone line or cellular Information sent over phone line or cellular service • Linked into EMR • Individual alerts Cardiocom – Remote Monitoring • http://www.cardiocom.com/video.asp HomeMed– Remote Monitoring • Honeywell • 27 patients currently monitored at CCHVC CHF clinic Once a day weight monitoring • Once a day weight monitoring • Requires analog phone line • Automatically turns on at same time every day to notify patient to use • Weight, HR, temp, SpO2 4 1/25/2016 PatientElectronicMedical Chart • CentraCare MyChart • Essentia MyHealth • Allows patients to order medications • See upcoming appointments and request appointments • See lab and diagnostic results • Email provider OnTracktoHealth • CentraCare Pilot • August 2012‐April 2013 • 17 patients • Medication adherence 88.6% in the 10 month Medication adherence 88 6% in the 10 month period • 33% reduction in CHF admissions • 47. 2% all cause reduction in hospitalizations in 12 months compared to prior 12 month period OnTracktoHealth OnTracktoHealth • Goals: Adherence, communication, education, monitoring • Can be access though EMR • Checked daily • Compliance with medications, weight, blood glucose, C li ih di i i h bl d l V.S., fluid intake • Components for LVAD patients (pulsitivity, flow, power, speed) • Apps for low sodium foods, ShopWell, MyFitnessPal • Connects though Wi‐Fi or cellular network • Have 40 patients currently monitored OnTracktoHealth • August 2012‐May 2014 • Used only on patients with a high readmissions risk (CORE score > 25%) • Average 30 day readmission risk score greater than 40% in p g program • Of those readmitted in <30 days, 83% had a risk score greater than 55% • Actual 30 day readmission rate for this highest risk population was 14.6% • Average HF readmission rate for all patients in the HF program during this time period was 19.6% • National average readmission is 23% OnTracktoHealth 5 1/25/2016 OnTracktoHealth • Dolly’s Story CardioMEMS CardioMEMS • Monitors PA pressure and can detect changes before a patient develops symptoms • Placed in the pulmonary artery • Early indicator of fluid retention Minimally invasive • Minimally invasive • Transmissions sent wirelessly • Daily transmissions • Permanent implant with no battery or replaceable parts CardioMEMS • Indications: NYHA level III and hospitalized in last year for CHF • Need to take dual antiplatelet therapy for one month after or Coumadin • Contraindications: GFR < 25 ml/min who don’t respond to diuretic therapy or ESRD • Contraindications: BMI >35 and chest circumference >165 cm CardioMems • • • • • • • • St. Jude 18 currently followed at CCHVC Data transmitted through cellular tower Can see all data dating since implant Individual thresholds Individual thresholds Systolic, diastolic, and mean pressure (mmHg) Can enter in medications and history Records HRs CardioMEMS • CHAMPION trial of Medicare eligible patients • 58% reduction in all case 30 day readmissions • 78% reduction for all cause CHF admissions • HFrEF patients already on guideline‐directed patients already on guideline‐directed medical therapy, pulmonary artery pressure guided management reduced HF hospitalization by 43% and mortality by 57% • Reduced hospitalizations by 37% over the course of 15 months and 28% in 6 months 6 1/25/2016 CardioMEMS CardioMEMS CardioMEMS BiventricularDevices“CRT” • https://www.youtube.com/watch?v=RDr‐FaKM7S8 BiventricularDevices“CRT” • Paces the lower chambers of your heart to help them beat in a more coordinated rhythm. This coordinating or “resynchronization” therapy improves the heart’s ability to pump blood and oxygen more efficiently to the body. • Certain companies have Heart Failure Management report that gives data on optival, impedance, HRs, HR variability, activity level, atrial fib burden and rates when in atrial fib. LeftVentricularAssistDevice 7 1/25/2016 RevealLINQDevice • Medtronic • 3 year longevity • MRI compatible • Detection of atrial fib and other arrhythmias • Detects the presence of AF in patients with AF with a sensitivity of 96.1% • Confirms the absence of AF in patients without AF with a Negative Predictive Value (NPV) of 98% • Used for syncope, palpitations, seizures, VT, atrial fibrillation, cryptogenic stroke RevealLINQDevice • Wirelessly connects • Uses MyCareLink monitor to transmit • No sedation • No sutures No sutures • Constant monitoring, but if patient has an event, they can use monitor to activate to save a recording • Automatic memory, where if it is programed to detect arrhythmias, it will automatically record if an arrhythmia occurs RevealLINQDevice RevealLINQDevice Summary References • Activated patients have the knowledge, skills, and confidence to manage their chronic illness and play an active role in improving their health outcomes and reducing cost. • Closing the feedback loop from collecting data transmitting data i i d evaluate l notify if intervene. i • Manage patients before they get into trouble • Manage patients between clinic visits • Proactive solutions, decrease hospitalizations • Decrease readmission rates • Decrease Medicare costs • Patients living prolong and improved quality of life • Atkin, P.; Barret, D. (2012). Benefits of Telemonitoring in the Care of Patients with Heart Failure. Nursing Standard. 27(4):44‐48. http://journals.rcni.com/doi/pdfplus/10.7748/ns2012.09.27.4.44.c9313. • Bonston Scientific. (2012). Latitude NXT and Latitude. http://www.bostonscientific.com/en‐ US/products/remote‐patient‐monitoring/latitude/video‐resources.html. • Cardiocom. (2016). Cardiocom. http://www.cardiocom.com/. • Centers for Disease Control and Prevention. (2015). Division of Heart Disease and Stroke Prevention: Heart Failure Fact Sheet . http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. • Desai, A. and Stevenson, L. (2012). Rehospitalization for Heart Failure: Predict or Prevent. Circulation. (126: 501‐506). http://circ.ahajournals.org/content/126/4/501.full. • Gheorghiade, M.; Vaduganathan, M.; Fonarow, G.; Bonow, R. (2013). Rehospitalization for Heart Failure: Problems and Perspectives. Journal of the American College of Cardiology. (Vol 6, Issue 4). http://content.onlinejacc.org/article.aspx?articleid=1481163. • Hall, M.; Levant, S.; DeFrances, C. (2012).Centers for Disease Control and Prevention. Hospitalization for Congestive Heart Failure: United States, 2000–2010. http://www.cdc.gov/nchs/data/databriefs/db108.htm. • Honeywell HomMed. (2005). Monitoring System User Guide. http://webcache.googleusercontent.com/search?q=cache:8aNwQFHtTGAJ:https://www.ho neywelllifecare.com/wp‐content/uploads/2012/10/P4430.05‐User‐ Guide.pdf+&cd=4&hl=en&ct=clnk&gl=us. 8 1/25/2016 References • Luetmer, R. (2016). OnTrack to Health. (Personal Communication). • Medtronic. (2016). Cardiac Diagnostics and Monitoring. Reveal LINQ ICM Device. www.medtronicdiagnostics.com/us/cardiac‐monitors/reveal‐linq/reveal‐linq‐cardiac‐ monitor/index.htm. • Medtronic. (2016). Heart Failure Management Report: Clinical Summary. http://optivol.medtronic.com/wcm/groups/mdtcom_sg/@mdt/documents/documents/20080123 5eenp1hfmrclinsum.pdf. • Medtronic. (2016). Medtronic CardioSight Reader. http://www.medtronic.com/for‐healthcare‐ professionals/products‐therapies/cardiac‐rhythm/patient‐management‐carelink/medtronic‐ cardiosight reader/index.htm. cardiosight‐reader/index.htm. • Medtronic. (2016). Medtronic CareLink Network. http://www.medtronic.com/for‐healthcare‐ professionals/products‐therapies/cardiac‐rhythm/patient‐management‐carelink/medtronic‐ carelink‐network‐for‐cardiac‐device‐patients/patient‐education‐materials/index.htm. • National Learning Consortium. (2016). Benefits of EHR: What is an Electronic Medical Record. https://www.healthit.gov/providers‐professionals/electronic‐medical‐records‐emr. • OnTrack to Health. (2016). OnTrack to Health. http://www.ontrack2health.com/contact‐ us;jsessionid=B5044AFDE5C9A0FCC9F810962F28BEBC • St. Jude Medical. (2016). CardioMEMS HF System: Pulmonary Artery Pressure Monitoring. http://professional.sjm.com/therapies/cardiomems/home. • St. Jude Medical. (2016). Merlin@home Transmitter. http://sjm.com/professional/products/crm/connectivity‐remote‐care/remote‐care/merlin‐home‐ transmitter#isw. • Thoratec. (2016). Left Ventricular Assist Device. http://www.thoratec.com/. • VanHeel, L. (2016). CentraCare Device Clinic. (Personal Communication). 9
