Remote patient monitoring: Nurse Talk

Nancy Carlson Weik BSN, RN is a practicing RN with extensive experience using remote monitoring solutions for cardiology patients.

I was immediately intrigued when I heard about the Heart Seat™. I suspect I am not the first person who felt the need to verify it was a real thing, and not someone’s attempt at bathroom humor. My entire nursing career has been in the area of cardiology, and while I’ve seen many improvements in remote patient monitoring devices, each has come with its own shortcomings and limitations. The Heart Seat presents a unique solution that addresses many of these challenges.

My journey through cardiac patient monitoring

As an RN working in the ICU and Cardiac Cath Lab environments in the 1990s, access to changing hemodynamics via invasive pressure monitoring was displayed in real-time on a monitor at the bedside. In addition to the “usual” vital signs, this gave the team a window into a patient’s clinical status relative to volume status and heart function.

Fast forward to my time in the implantable cardiac device industry, where utilization of cardiac resynchronization therapy (CRT) with biventricular pacing to improve ejection fraction in patients with mechanical dyssynchrony was underway. Patients had been receiving implanted defibrillators for secondary prevention of sudden cardiac death, meaning only after surviving a cardiac arrest. Clinical studies would show that the identification of patients at risk for sudden cardiac death would benefit from an implanted defibrillator as a primary prevention therapy.

Remote patient monitoring technology The inclusion of thoracic impedance as a vital sign, along with enhanced algorithms and device diagnostics, give providers a broader view of clinical status. Advances in patient and clinical alerts and remote monitoring options further improve patient outcomes and reduce hospitalizations.

Implantable devices are a solution but do not serve all patients

An implanted device may have customizable alerts which allow the clinician to triage a patient before symptoms may be present. These work well for a compliant patient who keeps their bedside monitor continuously plugged into power or their mobile app open and communicating with their implanted device, ensuring scheduled and alert transmissions can be received by the clinic in a timely fashion.

For patients who are less compliant with their remote monitoring devices, reliable data can only be gathered during in-person interactions. A clinician may wish they had access to changes in trended data sooner than they received it for a patient who only transmits on a sporadic basis. On the other hand, there are patients who choose to send daily, unrequested transmissions, which can interrupt clinic workflow and efficiency.

Not every cardiology patient has an implanted device with access to this data.

We need more reliable tools that enable proactive care

Patients may be manually taking their blood pressure once or twice daily. They may be stepping on a scale. Or maybe not. This data may be remotely sent to the provider or written down by the patient and brought to the next provider visit. Or maybe not. Some patients may forget to bring their log of measurements to their office visit and the clinician is left with only the real-time measurement obtained during the visit.

Some patients may resist taking these measurements and the first indication they are decompensating occurs when they are seen urgently in the office or emergency room; hospitalization may be unavoidable at this point. The patients you are most concerned with may be the ones you aren’t getting any data from–or possibly the data you are receiving is inaccurate due to various factors.

The Heart Seat strives to eliminate these issues. No implantable device = no problem. The Heart Seat would allow you to collect data from any patient, regardless of their implanted cardiac device status. No issue with data transfer once the battery-operated seat has been installed and connectivity established. No issue with inaccurate data from improper use. No issue with compliance; the patient continues with their daily activities while data is recorded by the Heart Seat when they use the bathroom. The Heart Seat could give us an entirely new window into clinical status in the home.

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Casana’s vision is to create effortless, in-home health monitoring solutions that allow care teams and their patients to achieve better health outcomes. The Heart Seat™ is Casana’s first product and is currently pursuing FDA clearance.