Am Heart Hosp J. 2010;8(1):25–8
Lozenge Reference
Original Contribution
Using Modern Communications to Manage Chronic Heart Disease
Alfred A Bove, MD, PhD
he modern approach to the care of patients with chronic cardiovascular disease (CVD) embraces a system that provides increased access to healthcare providers and creates a communication and education system that engages the patient, provides motivation for self-care, and allows frequent feedback to maintain optimal health status. Episodic care for patients with chronic diseases such as heart failure (HF), stable angina, diabetes, and others is costly and inefficient. Such an episodic approach to care also risks leading to deteriorating health as the patient is subjected to recurrent acute exacerbations of their illness that often require heroic therapies; by contrast, a system of continuous surveillance with frequent small changes in care prevents acute recurrences.
T
Management of the pre-symptomatic phase of heart disease (hypertension, hyperlipidemia) is best achieved using a patient-centered approach that incorporates patient participation, improved health literacy, and monitoring of patient status through frequent communication between patient and healthcare provider. Nurse management has proved effective in improving diabetes,1 hypertension.3
hyperlipidemia,2 and
Considering that the prevalence of these disorders is increasing disproportionately to the number of physicians and nurses, information technology could provide a solution for maintaining or improving clinical outcomes while containing costs.
A chronic care system should provide for measures of compliance, outcomes measurement, and routine reporting and feedback to patient, physician, health plan, and ancillary providers. Frequent surveillance of HF patients improves patient care and clinical outcomes.4
Provider-initiated
telephone surveillance has been shown to reduce the incidence of acute exacerbations of HF,5
but is labor-intensive
and expensive because direct phone contact with the patient by trained staff is needed to maintain the telephone surveillance system. The development of Internet-based communications offers a means to provide patients with access to their healthcare providers without traveling to an office or clinic and without depending on direct telephone contact. Internet-based systems can provide a framework for chronic medical management that facilitates patient–physician communication, personalization, and education but avoids the need for direct communication with a healthcare provider. A software-based disease-management system can be rapidly updated as new medical guidelines are developed, and is portable with no hardware required beyond a scale, sphygmomanometer, and access to the Internet.
Telemedicine System
This system provides Internet access to a personal health record (PHR) focused on CVD. The server contains the PHR database linked to a browser interface through secure firewalls. This arrangement allows patients to send data directly to their care provider via the Internet. Patient health information and the communication transactions are stored in the database. The website is divided into a patient domain and a provider domain. Each requires a login ID and password. This system provides Health
• Immediate Past President, American College of Cardiology, and Professor of Medicine (Emeritus), Temple University Hospital • Correspondence: Alfred A Bove, MD, PhD, Parkinson Pavilion Ste 920, 3401 N Broad St, Philadelphia, PA 19140-4105. E:
bovea@tuhs.temple.edu
Summer 2010 Using Modern Communications to Manage Chronic Heart Disease 25
We have used an Internet-based Telemedicine system to manage HF and CVD risk. The Telemedicine system (InSight Telehealth Systems, LLC, Valley Forge, PA) is a disease- management interactive health surveillance system comprising a secure Internet server and a database. Details of the Telemedicine system have been described in previous publications.6,7
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