Heart failure (HF) is characterized by high mortality, poor quality of life and frequent hospitalizations. The effectiveness of out-patient care for HF patients is unsatisfactory. Therefore the solutions that enable effective monitoring and assessment of HF patients’ clinical status become priority in treatment strategy. We propose to develop a model of care for HF patients based on modern non-invasive diagnostic tools and telemedicine. Clinical evaluation will be based on i.e. impedance cardiography, a simple non-invasive method of hemodynamic monitoring, including assessment of heart rate, blood pressure, left ventricular stroke volume, chest and total fluid status. The telemedicine system will enable rapid, appropriate to the patient's clinical status, therapeutic decision undertaken remotely by specialist. Implementation of the proposed model of care will contribute to a significant improvement in prognosis of HF patients (through i.e. improved access to specialist consultation, the early diagnosis of the deterioration of HF and the optimization of treatment). The significant economic, social and scientific benefits related to the project are also expected.
HEART FAILURE AS AN EPIDEMIOLOGICAL PROBLEM
Treatment of patients with HF is a great challenge for contemporary medicine. In European population HF frequency is assessed for 0.4 - 2%. In Poland it is approximately 0.8 - 1 million people. This disease characterizes with high morbidity and mortality rate, poor quality of life and the necessity of frequent hospitalizations. Along with the progress of medicine, in particular in the scope of the treatment of acute coronary syndromes, the number of HF patients is constantly growing. The essential problem in HF is its progress course and an increasing frequency of subsequent hospitalizations (approximately 30% of hospitalizations are the repeated ones). It is estimated that the costs of hospital stays constitute nearly 2/3 of healthcare costs provided for HF patients.
HEART FAILURE AND OUTPATIENT CARE PROBLEMS
The level of outpatient care for HF patients is not satisfying which results from numerous limitations (the main of which is a low availability of specialist care and modern diagnostic methods). HF patients are mostly in advanced age, frequently alone, burdened with severe disability, isolated from the society and support groups. There is a number of problems which result from the situation f HF patients in the current healthcare system: lack of an integrated care system, poor care coordination, poor organization of patient control system in the post-hospital period and a limited access of general practitioners to diagnostic tests. General practitioners mention obstacles such as: lack of facilities for appropriate investigations (especially echocardiography), lack of time and expertise, difficulty with diagnosis, fear of the modification of treatment recommended by a specialist (that results in failure of drug uptitration). Patients are deprived of specialist care, they are diagnosed too late (also in the scope of progress and destabilization of HF), treated with methods far from optimal ones (too high or too low drug doses, too fast abandonment of full treatment, application of contraindicated drugs), insufficiently educated.
THE AIMS OF THE PROJECT
The primary aim of the AMULET project is:
- development of a new model of medical care with the use of modern methods of noninvasive clinical assessment and telemedicine in HF patients that will improve their prognosis, availability of specialist care and reduce the costs of healthcare
The detailed aims are:
- development of a new model of ambulatory care based on ambulatory care points and telemetric supervision in order to reduce rehospitalizations, mortality and to improve quality of life of HF patients
- development of modern tools for data collection, storage and nalysis, based on modern IT technologies
- development of an interactive knowledge database about HF patients, useful in everyday medical care, scientific research and didactic activity
In the AMULET project we propose the solution including the interventions which so far turned out to be effective (specialist counselling, phone counselling programmes and telemonitoring). However, our system will be more advanced and supported by individualized assessment based on the impedance methods. Impedance cardiography (ICG), a method of haemodynamic assessment, is proposed as a fundamental diagnostic tool characterizing with easiness of performance, high diagnostic potential and relatively low costs. Performance of several-minute long ICG measurements enables the assessment of clinically important parameters such as heart rate, arterial blood pressure, cardiac/stroke index and chest hydration (fluid load). Additional assessment of the body composition (including water content) with bioimpedance method will be complementary to the complex clinical assessment. During the project we will assess the clinical value of these parameters to elaborate recommendations.
The telemedicine solutions will strongly support the proposed system. The clinical data will be automatically filled into an interactive system (database), which will send information to a supervising cardiologist, in accordance with the previously implemented decision support module. Based on the result a remote specialist recommendation will be generated. In terms of individual aspects, the electronic database will create a detailed patient’s history (continuum of changes of clinical parameters, therapeutic interventions), and as a whole it will be a multi-parameter registry of HF patients.
The IT system will constitute key support for the functionality of the suggested supervision solution in the following areas: teletransmission of protected medical data, acquisition of medical data, analysis of the main biological signals, registration of all diagnostic data in a timeline, ICG signal spectrum analysis with the detection of individual signal characteristics, creation of alarm subsystem based on the biological signals with an increased specificity. We will also perform the analysis of data chain and its variability in time, in order to increase the specificity of a single diagnostic measurement for a tested patient.
The advantages of the proposed care system are:
- individual approach and early detection of patient’s condition deterioration and acceleration of therapeutic intervention
- diversified form of care for HF patients, particularly taking into consideration the care continuum - from hospital admission to outpatient care
- optimization of treatment in accordance with the guidelines (both in the scope of drug dosage and therapeutic objectives)
- motivation to behaviour change also in the scope of the patient’s self-assessment and education
- improvement of specialist advise availability and expert consultation
Additional measurable effects will include:
- development of a network of collaborating centers treating HF patients
- development of advanced IT tools
- multiparameter clinical evaluation of HF patients
- assessment of changes in the clinical state of patient
- a platform with knowledge about HF patients
- an universal organizational model of care implementable for other groups of chronically ill patients
Funding: National Centre for Research and Development (NCRD) - Prevention Practises and Treatment of Civilization Diseases – STRATEGMED (STRATEGMED3/305274/8/NCBR/2017; total cost: 13 089 791 PLN; NCRD funding: 12 727 160 PLN)