Under observation. At home. This is the present, and especially the future, for heart disease. We will be treated in the e-Hospital. And not only for the online booking of specialist visits and exams such as an electrocardiogram, a stress test, a blood pressure or cardiac holter. Let’s get used to going much further. Studies conducted in the Covid era have shown that proactive home monitoring with tele-medicine and tele-monitoring is effective and safe even in people suffering from acute infectious diseases and in isolation at home. In addition to allowing a net decrease in hospitalizations, the average length of hospitalization and mortality and an important saving of resources.
As he explains Maurizio Volterrani, director of the Department of Cardiological and Respiratory Sciences of the Irccs San Raffaele in Rome, a clinical center that is part of the Network of Italian Cardiological Irccs, “cardiology has been working for some time to perfect technologies and devices that allow monitoring from home , in a very precise way, the patient’s biological signals and vital parameters (for example heart rate, blood pressure, the amount of oxygen in the blood) to decide whether to consult the doctor, change the therapy, undergo instrumental tests or be This, which we now call e-Hospital, is made possible by the use of equipment equipped with biosensors or photocells which, thanks to the smartphone, send data via remote / wireless communication to the medical and nursing staff. they are made available by the hospital after diagnosis “. The technology that makes telemonitoring possible is called Internet of Medical Things (IoMT) and refers to medical devices connected to a facility or healthcare provider via the Internet. The great advantage is that the physician can refer to clinical and biometric data in real time in various clinical situations, including monitoring of the post-hospital course, and to know in real time about an underlying problem or the need to adjust therapy.
So we will do the “televisions”
In addition to telemonitoring, television is gaining more value. “The first visit is important to be performed in person – Volterrani says – with the doctor who evaluates the patient, listens to his story, decides the strategy, but the follow-up visits to evaluate the progress of the disease and therapy can also be safely performed through a videoconferencing system.More studies have now confirmed that a check-up visit in person, or via videoconference, are comparable in terms of results: the fact that there is a visual exchange gives an added value. Similarly, in addition to the follow-up, cardiological rehabilitation sessions after an acute event (myocardial infarction, heart failure, cardiac surgery such as coronary artery bypass grafting) can now be carried out, in almost all circumstances, at home. thanks to the videoconference connection, with a physiotherapist who follows the patient in the rehabilitation program “.
What is needed
Telemedicine in cardiology has accelerated and improved characterization following the pandemic. As Volterrani recalls, “In this period, out of fear or objective restrictions, 35-40% fewer patients went to hospital for a heart attack or a cardiovascular event, which means that untreated heart attacks have become chronic in important diseases such as heart failure, on the rise. Centers and hospitals like ours that had already implemented the use of telemedicine for some time, before the pandemic, have enhanced their television and telemonitoring services. part of maintaining a high level of performance, on the other of obtaining a decidedly significant satisfaction from the patient. Furthermore, it is also essential that the staff is trained to manage the patient in this way. In our case the nurse is like a ‘case manager’: calls the patient at scheduled intervals for a follow-up, but the patient has the possibility to call the center as many times as he deems appropriate. his way of bilateral contact, the patient feels “pampered”. As a center we have access to a quantity of data that allows us to manage it in the best possible way “.
The importance of a homogeneous service
“In the future, the use of television will increase and efforts will be made increasingly to manage the patient outside the hospital for outpatient activities, including pre-hospitalization; hospitalization will be reserved for extremely severe cases or where it is necessary for reasons of force majeure – concludes Volterrani – The homogeneous strengthening of the internet network in Italy is certainly needed and the Ministry of Health has issued guidelines that tend not only to develop telemedicine, but to overcome fragmentation and the lack of homogeneity of the cardiological services offered in the area, with the introduction of reference standards. These aspects are particularly important in some situations: when patients live at a long distance from the centers, or for different reasons they cannot access the centers, but also in situations of emergency / urgency as during the pandemic. Within a few years, telemedicine will therefore become one of the services available of the citizen “. Finally, the development of increasingly advanced devices will allow the patient to be telemonitored even better at home based on their pathology.