Tele-heart

CNCs will help trial a service designed to help patients with severe cardiac difficulties communicate better with the health system. 

Nurses will play an integral role in an upcoming telehealth trial by supporting patients with chronic heart failure (CHF) in the community.

Clinical nurse specialists who work in heart failure management will meet with patients who have experienced CHF to develop care management and heart failure action plans, which telehealth technology will help implement.

“The heart failure action plan really outlines activity that the patient needs to do if they start to deteriorate clinically,” said lead investigator Dr Andrew Maiorana, associate professor at Curtin University’s school of physiotherapy and exercise science. “All of this will be supported by telehealth.”

Patients will be encouraged to log their information and updates, such as symptoms and daily weight, online at home. Information from monitors – including blood pressure, activity and weight – will be automatically uploaded onto a patient management database.

“The idea of this program is to support patients in their self-management but also to link patients into their GP when their symptoms start to worsen or their clinical situation starts to deteriorate,” Maiorana said. “Heart failure is associated with a high rate of readmissions to hospital but a lot of these are preventable if patients undertake good self-care activity.” He added that the cost of CHF to the healthcare system is more than $1 billion annually.

Dr Robert Grenfell, national director of cardiovascular health at the Heart Foundation, also stressed the size of the problem.

“Chronic heart failure is a major public health issue,” Grenfell said. “Despite significant advances, health outcomes are poor for people with heart failure and the financial and emotional costs are incredibly high.”
The trial aims to examine whether telehealth technology can reduce emergency department presentations, hospital admissions and numbers of bed days. Investigators also hope to establish whether it is a cost-effective and manageable tool for patients.

The project grew out of a community-based heart failure management service known as Smart Heart, which was already established at Curtin University in 2013. Appropriate patients at Perth’s major tertiary hospitals were referred post-discharge to the service – which was led by nurses – for ongoing support.

The trial is slated to begin in July or August and has funding of $350,000 over two years. Maiorana said early feedback from nurses he has spoken to has been positive. “What we’re trying to deliver is a cutting-edge approach, using technology to assist nurses in helping patients manage their heart failure,” he said.

The service would not only help patients but also practice nurses, through improved lines of communication with patients, resulting in regular updates on their clinical condition and assisting in their management.

Using the information gained to link patients in to their GP will upgrade the skills of both the GP and practice nurses, Maiorana said. He added that a strong focus on co-ordinating care through communication lines would help with timely medical follow-ups and reduce hospital admissions.

Grenfell said the project was a good step towards testing the role of telehealth in the multidisciplinary health system that’s required to care properly for patients with heart failure.

“Chronic heart failure is a condition that is with patients for life, and it presents daily challenges.” Grenfell said. “Helping patients manage this serious and difficult disease can help [them] control the symptoms of heart failure, avoid unnecessary hospital visits and live a longer, healthier life.”

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