"AI-based Telemonitoring is The Future"
In the following interview, Dr. Panorea Styllou from the Isar Heart Centre (Isar Herzzentrum) at the Isar Klinikum in Munich shares fascinating insights into her experiences with Remote Patient Monitoring (RPM), its benefits for both patients and medical professionals, and the future of digital cardiology.
About
Dr. Panorea Styllou is a specialist in cardiology and internal medicine. She holds additional qualifications in emergency medicine, sports medicine and nutritional medicine and has numerous additional qualifications such as sports medicine, prevention, heart failure and interventional cardiology. As head of the Chest Pain Unit, the cardiac catheterization laboratory, internal intensive care medicine and the pacemaker outpatient clinic, she deals with the diagnosis and treatment of patients with cardiovascular diseases - especially heart failure - on a daily basis. In addition to her clinical work, she is actively involved in various professional associations, including the German Society of Cardiology (DGK) and is a member of the European Society of Cardiology (ESC), the Bavarian Association of Sports Physicians (BSÄV) and the German Society for Sports Medicine and Prevention (DGSP).
Photo: Dr Panorea Styllou, (c) Isar Hospital Munich
Dr. Styllou, you look after patients with heart failure on a daily basis. What challenges do you see in the traditional treatment of these patients, and how can Remote Patient Monitoring provide support here?
The challenge in the traditional treatment of these patients lies, among other things, in the long periods of time between appointments with the doctor. Weeks or even months often pass between these appointments, creating a kind of "black box" for the doctor. As a result, health problems are often only recognized late, which leads to reactive rather than proactive treatment. Adjustments such as new medication, changes in dosage or changes in medication must be made individually based on the patient's condition, blood values and blood pressure. However, individualized medicine requires fast and seamless care.
In medicine and research, there is the so-called "gender health gap", which states that the treatment of women and men differs, partly due to the continuing lack of data on women's health. How do you encounter this phenomenon in everyday clinical practice and what is already being done to close this gap and provide better cardiological care for women?
Despite the long-known gender-specific differences in medicine, women are still underrepresented in scientific studies, clinical-pharmacological studies, interventional studies and basic scientific studies. Women are older and sicker at the time of diagnosis and treatment initiation, which increases the complication rate and increases hospital mortality. A typical example in cardiology is myocardial infarction: women have significantly worse chances of survival after a heart attack than men. This is also due to the fact that they often have atypical symptoms or their complaints are not taken seriously. (SEMDATEX note: You can read more about the typical heart attack symptoms in women here)
It is important not to limit ourselves to doctors and nurses in hospitals in terms of improving outcomes. Awareness must also be raised in the pre-hospital sector, among staff in emergency and intensive care medicine, paramedics, emergency medical technicians and paramedics. Education, continuous training and further training of all professional groups in medicine are essential in order not to allow women to be at a disadvantage when it comes to the "gender health gap" due to loss of time in diagnosis and treatment.
You use the inCareNet solution for remote monitoring. What impact has the use of this technology had on everyday treatment and patient care in your clinic?
Remote monitoring with inCareNet has become an integral part of our day-to-day care at the Isar Heart Center. Objective and subjective data are recorded and evaluated. We live individualized medicine. It is another piece of the puzzle that supplements, optimizes and completes the picture of care for heart failure patients. We have already been able to avoid several cardiac decompensations and hospitalizations as a result.
Which clinical parameters are particularly important for monitoring patients with heart failure, and how does inCareNet help you to detect deterioration at an early stage?
The key to success here is seamless medical care and the rapid detection of and response to deteriorations in heart failure. Figuratively speaking, the doctor is at the patient's side every day and evaluates their daily data. This happens even before symptoms occur, when the first signs are recognizable from the values or when symptoms are still mild.
Depending on whether the patient uses external sensors (personal scales, blood pressure monitor, ECG recorder) or is fitted with an ICD and/or CRT, different data can be transmitted and evaluated. With the external sensors, weight, heart rate, blood pressure and the ECG of the day are transmitted. The patient can simply write the ECG himself by placing the recorder on the patient.
We cardiologists become particularly aware of weight gain, an increase in heart rate, low blood pressure or the occurrence of cardiac arrhythmias such as atrial fibrillation in the transmitted ECG. We at the Telemedicine Center (TMZ) evaluate everything and contact the patient by telephone. Medication can be adjusted immediately and we can see the effects immediately or often the very next day. The transfer is even easier for patients with an ICD and/or CRT. Regardless of the manufacturer, we have special algorithms where conspicuous parameters such as malignant cardiac arrhythmia, conspicuous probe values, low battery status or even shocks are transmitted. This means that countermeasures can be taken quickly, the patient does not (yet) have to see a doctor and hospital stays can be avoided. The financial costs avoided in the healthcare system are enormous and currently a hot topic. However, it should not be forgotten that, in addition to quality of life, the patient's survival is also at stake. This is because every cardiac decompensation and hospitalization triggers the negative spiral and increases cardiac mortality.
How do your patients experience remote monitoring? Is there any feedback on greater safety or a better quality of life as a result of continuous monitoring?
After the indication check, a detailed discussion about the advantages of telemonitoring takes place as part of the patient's information and consent - including data protection. This allows any concerns to be quickly dispelled. Only anonymized data is entered into the platform and only the Telemedicine Centre (TMC) can identify the respective patient.
Patients benefit from telemonitoring in several ways: through the convenient, automatic transmission of their data, an optimization of care through transmission even outside consultation hours, more self-confidence (patient empowerment), better symptom control, more understanding of their own illness, reduction or avoidance of hospital stays, better quality of life and ultimately a reduction in mortality.
What challenges still exist in the implementation and use of remote patient monitoring, for example in terms of acceptance, data protection or integration into existing care structures?
Unfortunately, remote patient monitoring (RPM) is still underused. There is still insufficient awareness among doctors (cardiologists in private practice or GPs), but there is also skepticism towards digital media and a lack of financial incentives. The shortage of specialists in medicine also plays a role here - this has not only existed since the COVID-19 pandemic. With regard to integration into existing care structures, it should be borne in mind that patients who do not live in metropolitan areas but in rural areas where doctors and medical care are difficult and laborious to reach can also be cared for quickly and easily. Telemedicine compensates for differences in care for patients in structurally weak areas, which is an important social aspect.
Digitalization in the healthcare sector is progressing steadily. How do you see the future of telemedicine, particularly in relation to cardiovascular diseases and their prevention?
Digitalization has found its way into all of our lives and, of course, into the healthcare sector. We are confronted with a flood of data. However, it is not the collection of data that is the crucial point, but the validation of this data and the resulting therapeutic consequences. Telemedicine is a tool and should not replace medical thinking and treatment decisions. Nevertheless, AI-based monitoring is the future. In view of the increasing scarcity of resources, artificial intelligence is the key to processing and utilizing the masses of data that are overwhelming us in the healthcare sector like an avalanche.
Telemonitoring should therefore not only be seen as a possibility, but as a necessary component of medicine. Not only heart failure therapy benefits from telemonitoring, almost every cardiovascular disease offers the possibility of telemedical optimization. Telemedicine has also long been used for mental illnesses such as depression, metabolic diseases such as obesity or diabetes mellitus, migraines or in teleradiology. Telemedicine has also long since found its way into the prevention of cardiovascular diseases. We are seeing people - not (yet) patients - tracking their values, whether by means of pedometers, during sport or while sleeping. More and more people are using health apps (DiGA) in the areas of wellness, sport or lifestyle. The potential is huge and should be exploited.