A mobile program for people living with heart failure has not only transformed their care, but is keeping patients safe in times of COVID-19 isolation.
The program is called Medly: a fully functioning heart failure remote management system developed by the Ted Rogers Centre for Heart Research and UHN’s eHealth Innovation and rolled out at the Ted Rogers Centre of Excellence at the Peter Munk Cardiac Centre.
By the beginning of March, Medly had linked more than 600 patients with heart failure from their home to expert clinical staff at the hospital. As the reality of COVID-19 emerged, the clinical team sought to increase the patients they could onboard to Medly, and now plans to monitor hundreds more patients in the coming weeks.
When it comes to heart failure, even small changes in symptoms can be dangerous for patients, or a sign that the disease is worsening. Warning signs include an increased heart rate, weight gain, shortness of breath, swelling in the ankles, and blood pressure changes. Ideally, patients are educated to stay on top of these symptoms, and for doctors to adjust treatment as necessary.
Also ideally, these people avoid unnecessary trips to the hospital, which can worsen their outcomes.
Keeping cardiac patients safe at home
Each morning, patients record their weight, blood pressure, heart rate and symptoms they are feeling into Medly. Then, based on individual parameters set for them by their cardiologists, an algorithm filters the information and sends a message back to them, such as: everything is okay, keep following the care plan; you need to visit emergency; we need to adjust medication.
Meanwhile, the system alerts the health-care team back at the Ted Rogers Centre of Excellence if a patient’s status is deteriorating. There, nurses monitor hundreds of patients on a dashboard and build a clinical picture of each patient, which enables physicians to make clinical adjustments without the patient needing to visit the hospital. These are patients not only in the Toronto area, but across Ontario – even in remote locations.
“Through the app, we can inform patients if they need to change their medications while we send that prescription to a pharmacy,” says nurse Mary O’Sullivan. “Medly provides rapid access to specialized care that patients would otherwise have to go through regular health-care system channels to receive.”
Reducing rehospitalizations by 50 per cent
Medly is also proven to work. Over a six-month study, researchers found that Medly was responsible for reducing re-hospitalizations for heart failure by 50 per cent – and reducing hospital stays for any reason by 24 per cent. It shows that this telemonitoring program can not only keep patients safe at home, but improve their clinical outcomes and quality of life.
“This is a ground-breaking change in terms of our ability to manage patients with heart failure in between their episodes of care, and critically, to keep patients out of hospital,” says Dr. Heather Ross, Ted Rogers Centre scientific lead and Cardiology Division Head at Peter Munk Cardiac Centre.
Mary says that Medly helps her patients take greater ownership of their own care. “Checking one’s vitals and receiving feedback from their expert team has really engaged them, and enabled them to take better care of themselves,” she says.
Over time, Medly becomes a routine part of each patient’s life, and Mary says they trust it to give them the information they need in order to modify their behaviour (such as nutrition) and manage their condition.
“They treat it like a prescription from the cardiologist,” Mary says, adding that the app is so intuitive that she even taught it to a man who was 94 and had only ever used a rotary phone.
Medly is currently being explored at many Ontario hospitals for heart failure as well as other chronic illnesses. In the time of COVID-19, and in all future scenarios where self-isolation is necessary, keeping patients safe in their homes becomes vastly more urgent.