CLINICAL
NEWS
American College of Cardiology Extended Learning
What’s News? If you are interested in mHealth, check out mobihealthnews.com.
Here is some recent news:
June 22, 2016
Ochsner Health System in New Orleans was able to get a little over two-thirds of their out-ofrange hypertension patients within range in 90 days by having those patients measure their blood
pressure once a week with a connected device.
July 5, 2016
UnitedHealthcare teamed with a health coaching startup Vida for a study of 1,000 high-body mass
index patients. Over a period of 5 months, >58% lost weight, including 30% who lost more than
5% of their body weight. At baseline, 31% of the group had a systolic blood pressure >140 mm Hg.
Using various means, coaching reduced that to 11% at 5 months.
July 7, 2016
Investment in digital health for the first half of 2016 reached $3.9 billion, breaking funding records
and showing a robust market that is expected to continue growing.
July 7, 2016
The National Institutes of Health (NIH) has launched a Participant Technologies Center to test and
maintain connected sensor technologies as part of the White House’s Precision Medicine Initiative. Towards that end, the NIH has awarded $120 million to Scripps and others to enroll 350,000
participants in the program via mobile apps.
and self-monitoring of behavior. Overall, there was
an average of about seven (OK, it was 6.6) such
techniques per app.
The good news: there is a base of evidence supporting some of those behavior-changing techniques Conroy and colleagues evaluated; the bad
news is that’s not what the most popular apps are
providing. Most of them had attractive interfaces,
sure, but the apps favored behavior-changing techniques with a modest evidence base over others
with more established evidence of efficacy. Overall,
almost all of the apps are busy trying to find ways
to help the user connect with Facebook, Twitter,
and Instagram rather than promote active self-monitoring by users.
People are not shy about
sharing: 97% of those
surveyed said they are
willing to share personal
health data, with just a
few ranking data privacy
as an important feature
of a health plan.
24
CardioSource WorldNews: Interventions
Don’t necessarily blame the consumer here. In
late June, a survey demonstrated that people don’t
crave the latest fitness wearable. Their overwhelming preference is for simple applications that provide and organize information.
The survey of 500 people was conducted for
PwC’s Strategy& (that’s not a random abbreviation
and a typo, by the way!). With spelling and spacing
issues taken care of, here is what the survey found:
• The five most preferred features were out-ofpocket cost estimators, simple access to health
records (both online and mobile), mobile
post-care instructions, online appointment
scheduling with in-network providers, and a
centralized payment portal to both health plan
and provider.
• The second category, labeled as “Nice to Have,”
included things that would enhance current
health plans, such as telehealth and mobile
consultations, personalized health and wellness predictors, and ratings tools for quality
transparency.
• Even though wearables linking to health records
and remote monitoring systems may be flashy
(and enticing to health care providers and necessary to gather data to evaluate their worth), consumers rank those among the least important,
along with health goal-management programs
and interactive tools for self-diagnosis.
And people are not shy about sharing: 97% of those
surveyed said they are willing to share personal
health data, with just a few ranking data privacy as
an important feature of a health plan.
TELE-HEALTH READY MADE FOR CVD
We mentioned tele-health in passing. In June 2016,
the Agency for Healthcare Research and Quality
released a report indicating that the top chronic
conditions for telehealth success were cardiovascular disease (CVD) and respiratory disease. Investiga-
tors conducted a systematic review and found “a
large, broad evidence base about the effectiveness
of telehealth, including over 200 systematic reviews
and hundreds of primary studies published since
2006.”4 They identified a substantial amount of
evidence, including 58 systematic reviews that
covered several important clinical focus areas and
met their inclusion criteria.
Twelve reviews covered CVD and an additional
eight dealt with diabetes. The former included
studies of telehealth for the management of heart
failure, acute care and follow-up for myocardial
infarction, management of patients with implantable defibrillators, and primary and secondary
prevention of coronary disease; the latter included
management of type 1, type 2, and gestational diabetes and a target range of activities from regulating glucose levels to promoting physical activity.
CVD/remote patient monitoring had the most
evidence followed by psychotherapy and behavioral health. The most consistent benefit for
telehealth has been for communication and counseling or remote monitoring in chronic conditions
such as cardiovascular and respiratory disease,
with improvements in outcomes such as mortality, quality of life, and reductions in hospital
admissions.
Given sufficient evidence of effectiveness for
these topics, the report concludes that future
research should shift to implementation and
practice-based research. ■
REFERENCES:
1. O’Connell S, ÓLaighin G, Kelly L, et al. PLoS One.
2016;11:e0154956.
2. Evenson KR, Goto MM, Furberg RD. Int J Behav Nutr Phys
Act. 2015;12:159.
3. Yang CH, Maher JP, Conroy DE. Am J Prev Med.
2015;48:452-5.
4. Totten AM, Womack DM, Eden KB, et al. Telehealth: Mapping the Evidence for Patient Outcomes From Systematic
Reviews. Technical Brief No. 26. AHRQ Publication
No.16-EHC034-EF. Rockville, MD: Agency for Healthcare
Research and Quality; June 2016.
Take-aways
• With the $3 trillion health care industry moving
more towards consumer choice, patients are
being asked to assume more responsibility for
managing their own care as well as take a more
active role in their overall health and wellness.
• In response, insurers and health care companies
are rolling out new products and services that
empower patients, but there is a disconnect
between what’s being offered and what patients
want in terms of digital (or mHealth) resources.
• A new government report finds that
cardiovascular disease has the most evidence
to support the use of tele-health to improve
outcomes such as mortality, quality of life, and
reductions in hospital admissions.
September/October 2016