Are we there yet?: The reality of remote monitoring

Remote monitoring and high-tech health management solutions have dominated cardiology headlines for the better part of the past year, touted for their accessibility and preventive benefits. But that vision of remote monitoring as the future of CV care might be a skewed representation of our current reality.

At MedAxiom’s fall CV Transforum in Dana Point, Calif., this October, John Rumsfeld, MD, PhD, chief innovation officer for the American College of Cardiology, talked digital transformation and weighed in on the feasibility of innovations like remote monitoring, AI and virtual care. And he has a message for cardiologists when it comes to those tech-driven interventions: slow down.

“We’re putting our whole innovation effort, or a major part of it, into remote monitoring,” Rumsfeld said. “And yet, our own clinical practice guidelines are pretty lukewarm on the state of remote monitoring.” 

Focusing on remote monitoring in the context of heart failure, Rumsfeld said that current guidelines—including those from the ACC, American Heart Association and European Society of Cardiology—admit the evidence for remote monitoring of HF is “mixed.” They cite “variable clinical trial results,” and even in the case of CardioMEMS, an implantable sensor that’s been met with great success, the highest level of recommendation is class IIb, level B.

The Heart Failure Society of America is more straightforward, writing in a 2018 white paper that “based on available evidence, routine use of external remote patient management devices is not recommended.”

What professional groups are saying, though, is easily clouded by the hype generated by Silicon Valley. Hundreds of brands, including both startups and established businesses, are vying to get in on the ground floor of remote monitoring—if only for the financial opportunity.

A collaboration between these tech companies and the clinical world is critical to fashioning remote monitoring tools that actually help patients, Rumsfeld said. Evolving technology can help cardiologists ID patients who might be at an increased risk for disease before any outward symptoms are apparent, and that’s something we struggle with right now. Rumsfeld suggested intrathoracic impedance, autonomic adaptation and PA pressures as important factors for facilitating an earlier diagnosis. 

“Traditionally, when we’ve done remote monitoring, we’ve focused way to the right on this,” he said. “We’re asking patients if they’re getting short of breath, we’re having them do weights. But by the time patients are short of breath, there are a lot of people who are just saying, it’s too late. We can’t then stop the decompensation and stop the hospitalization.

“What we need to do is leverage technology to move left.”

Co-creation between tech companies and clinicians will produce the best results, Rumsfeld said, noting one case in which William T. Abraham, MD, a noted cardiologist, left Ohio State to join the startup “V-Wave.” V-Wave developed a shunt that’s fixed between the left and right atriums such that left atrial pressure actually shunts a small amount of blood to the right atrium. Rumsfeld said the tech is “very novel and totally unproven” at this point, but the company has at least gathered enough information to gain FDA approval for a pivotal trial—something most startups fail to do.

“I’d actually be very careful about the over-adoption of digital and AI stuff right now,” he said. “That kaleidoscope of technology and all these companies coming to your practices and telling you, ‘We can do this, we can do that.’ Just be careful. They’re way overpromising.”

Cardiology’s “digital transformation” hasn’t happened yet, and Rumsfeld said it won’t without a new approach. We need ways to ensure remote monitoring is being used as intended to make sure it’s as successful as possible, and we have to adjust the payment system to align.

“Everybody talks about disruption, but you know what the problem is with disruption in healthcare? You don’t want to disrupt the parts that work,” Rumsfeld said. “Because we actually save lives and take care of people. You have to go at it a different way.”