A new model
of ambulatory care
with the use of modern methods of noninvasive clinical assessment and telemedicine in heart failure patients
See how AMULET works

The project is run by a Scientific Consortium consisting of:

Principles, goals and results of the AMULET project
01

Heart failure is a significant clinical, social and economic problem that poses a huge challenge to health care systems. In Poland, nearly 1.4 million people suffer from heart failure and almost one in ten of them dies every year. Despite continuous medical progress and the implementation of new therapies, the prognosis of patients with heart failure remains poor. The economic and social costs of heart failure are very high and have shown a steady upward trend in recent years.

Heart failure is the cause of more than 10% of all hospitalisations in Poland. The most serious problem is repeat hospital admissions after discharge, which worsen patients’ prognosis. They account for more than 95% of the costs of care for patients with this condition in Poland.

The quality of outpatient care for patients with heart failure is not satisfactory, due to many limitations of the health care system, primarily the low availability of specialist care and modern diagnostic methods. Heart failure itself is responsible for a number of barriers to accessing medical care – patients with this condition are usually elderly, often live alone, and suffer from significant disability and isolation from the community and support groups.

Well-organised outpatient care is vital for reducing the hospitalisation rate and improving the prognosis of patients with heart failure. That is why we have created an outpatient medical care model that utilises modern methods for non-invasive clinical assessment and telemedicine.

02

The AMULET project is a telecare system based on ambulatory care points (ACPs) where the primary role is played by qualified nursing staff. The goal is to limit the involvement of cardiologists in outpatient care to absolutely necessary procedures. Personal contact with the physician is replaced with telephone consultations, but at the same time high-quality patient assessment is ensured by the use of modern non-invasive diagnostic tools, such as impedance cardiography (ICG) and bioimpedance body composition analysis. In this model, the comprehensive clinical assessment consists of the measurement of key clinical parameters (the so-called vital signs), i.e. heart rate, arterial blood pressure, arterial blood oxygen saturation level, body weight, accumulation of fluid in the chest, and total body water.

The AMULET follow-up visit plan is aimed at intensifying care shortly after discharge and keeping the patient stable during subsequent appointments. Complete clinical data is entered into the telemedicine platform, which allows health care professionals to access the patient’s data and make treatment-related decisions remotely. Additionally, a recommendation support module based on objective haemodynamic parameters has been implemented to optimise and tailor pharmacotherapy to the patient’s individual haemodynamic profile.

The ACP-based care model is complemented by the option to monitor selected patients, such as those at increased risk of sudden decompensation, in the home setting. The AMULET project also includes a concept for a home-use device to assess fluid build-up in the chest. It records baseline thoracic impedance and its fluctuations over time. The data is sent to the telemedicine platform, where it can be analysed and integrated with other medical data (e.g. information on symptoms, which the patient can report via a dedicated mobile application). This solution can be used for any patient, but it has the potential to be particularly beneficial to patients with unstable symptoms and/or patients recently discharged after hospitalisation caused by exacerbation of heart failure.

03

Haemodynamic test results are presented on the AMULET platform against scaled alarm ranges referred to as the recommendation support module (RSM). Based on the evaluation of the absolute values of selected parameters and their fluctuations over time, the physician assessing the result remotely is presented with recommendations on how to proceed.

Each alarm indicates a corresponding therapeutic procedure, which is then taken into consideration by the physician when making the final decision. An important functionality is the ability to plan new limit values for the alarm ranges for the next visit, corresponding to the future therapeutic goals.

04

The solutions developed in the AMULET project give an opportunity to improve the prognosis of patients with heart failure by increasing the availability of specialist care, effective detection of symptoms indicating the risk of exacerbation of this disease, adapting treatment to the individual needs of the patient, and as a result reducing the number of emergency hospitalizations.

05

The AMULET platform meets the needs of the telecare system for chronically ill patients and improves its implementation. Its functionalities include:

  • the ability to register centres participating in the programme and specify their profile and referral level
  • the ability to register health care professionals from the participating centres and specify their category and qualifications
  • advanced data access management, including mechanisms for granting access to medical data in accordance with the role played in the process and for ensuring the highest level of protection against unauthorised access
  • the ability to record patient visits and completed procedures in the platform calendar and to specify the medical staff participating in each event
  • communication between health care professionals, e.g. in the form of video or telephone consultations
  • a system for reporting and generating summary lists (e.g. of completed procedures)
  • a tool (e.g. an application) that allows patients to submit information on their medical parameters (e.g. body weight, arterial blood pressure, or amount of physical activity per day)
06

The implementation of a health care model based on ambulatory care points is the main, but not the only outcome of the AMULET project. We have also developed a new mobile device that allows patients to monitor their vital signs at home.

Based on analysis of the medical data obtained from the project, we have created advanced prediction models that support the diagnostic and therapeutic processes.

The data we have collected is a rich source of knowledge about patients with heart failure. It may be used in the future for scientific purposes (e.g. in exploratory data analysis) and in education.

01Why was the AMULET project created?

Heart failure is a significant clinical, social and economic problem that poses a huge challenge to health care systems. In Poland, nearly 1.4 million people suffer from heart failure and almost one in ten of them dies every year. Despite continuous medical progress and the implementation of new therapies, the prognosis of patients with heart failure remains poor. The economic and social costs of heart failure are very high and have shown a steady upward trend in recent years.

Heart failure is the cause of more than 10% of all hospitalisations in Poland. The most serious problem is repeat hospital admissions after discharge, which worsen patients’ prognosis. They account for more than 95% of the costs of care for patients with this condition in Poland.

The quality of outpatient care for patients with heart failure is not satisfactory, due to many limitations of the health care system, primarily the low availability of specialist care and modern diagnostic methods. Heart failure itself is responsible for a number of barriers to accessing medical care – patients with this condition are usually elderly, often live alone, and suffer from significant disability and isolation from the community and support groups.

Well-organised outpatient care is vital for reducing the hospitalisation rate and improving the prognosis of patients with heart failure. That is why we have created an outpatient medical care model that utilises modern methods for non-invasive clinical assessment and telemedicine.

02How will the project’s results support patients with heart failure?

The AMULET project is a telecare system based on ambulatory care points (ACPs) where the primary role is played by qualified nursing staff. The goal is to limit the involvement of cardiologists in outpatient care to absolutely necessary procedures. Personal contact with the physician is replaced with telephone consultations, but at the same time high-quality patient assessment is ensured by the use of modern non-invasive diagnostic tools, such as impedance cardiography (ICG) and bioimpedance body composition analysis. In this model, the comprehensive clinical assessment consists of the measurement of key clinical parameters (the so-called vital signs), i.e. heart rate, arterial blood pressure, arterial blood oxygen saturation level, body weight, accumulation of fluid in the chest, and total body water.

The AMULET follow-up visit plan is aimed at intensifying care shortly after discharge and keeping the patient stable during subsequent appointments. Complete clinical data is entered into the telemedicine platform, which allows health care professionals to access the patient’s data and make treatment-related decisions remotely. Additionally, a recommendation support module based on objective haemodynamic parameters has been implemented to optimise and tailor pharmacotherapy to the patient’s individual haemodynamic profile.

The ACP-based care model is complemented by the option to monitor selected patients, such as those at increased risk of sudden decompensation, in the home setting. The AMULET project also includes a concept for a home-use device to assess fluid build-up in the chest. It records baseline thoracic impedance and its fluctuations over time. The data is sent to the telemedicine platform, where it can be analysed and integrated with other medical data (e.g. information on symptoms, which the patient can report via a dedicated mobile application). This solution can be used for any patient, but it has the potential to be particularly beneficial to patients with unstable symptoms and/or patients recently discharged after hospitalisation caused by exacerbation of heart failure.

03What is the recommendation support module?

Haemodynamic test results are presented on the AMULET platform against scaled alarm ranges referred to as the recommendation support module (RSM). Based on the evaluation of the absolute values of selected parameters and their fluctuations over time, the physician assessing the result remotely is presented with recommendations on how to proceed.

Each alarm indicates a corresponding therapeutic procedure, which is then taken into consideration by the physician when making the final decision. An important functionality is the ability to plan new limit values for the alarm ranges for the next visit, corresponding to the future therapeutic goals.

04What benefits have we obtained?

The solutions developed in the AMULET project give an opportunity to improve the prognosis of patients with heart failure by increasing the availability of specialist care, effective detection of symptoms indicating the risk of exacerbation of this disease, adapting treatment to the individual needs of the patient, and as a result reducing the number of emergency hospitalizations.

05What are the advantages of the AMULET system?

The AMULET platform meets the needs of the telecare system for chronically ill patients and improves its implementation. Its functionalities include:

  • the ability to register centres participating in the programme and specify their profile and referral level
  • the ability to register health care professionals from the participating centres and specify their category and qualifications
  • advanced data access management, including mechanisms for granting access to medical data in accordance with the role played in the process and for ensuring the highest level of protection against unauthorised access
  • the ability to record patient visits and completed procedures in the platform calendar and to specify the medical staff participating in each event
  • communication between health care professionals, e.g. in the form of video or telephone consultations
  • a system for reporting and generating summary lists (e.g. of completed procedures)
  • a tool (e.g. an application) that allows patients to submit information on their medical parameters (e.g. body weight, arterial blood pressure, or amount of physical activity per day)
06What makes the AMULET project so unique?

The implementation of a health care model based on ambulatory care points is the main, but not the only outcome of the AMULET project. We have also developed a new mobile device that allows patients to monitor their vital signs at home.

Based on analysis of the medical data obtained from the project, we have created advanced prediction models that support the diagnostic and therapeutic processes.

The data we have collected is a rich source of knowledge about patients with heart failure. It may be used in the future for scientific purposes (e.g. in exploratory data analysis) and in education.

The total cost of the AMULET project was over PLN 13 million, of which PLN 12.7 million was provided by the Polish National Centre for Research and Development under the STRATEGMED III programme. The implementation of the project began on 1 May 2017.