The Social Robots Are Coming: Preparing for a New Wave of Virtual Care in Cardiovascular Medicine

HomeCirculationVol. 145, No. 17The Social Robots Are Coming: Preparing for a New Wave of Virtual Care in Cardiovascular Medicine Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBThe Social Robots Are Coming: Preparing for a New Wave of Virtual Care in Cardiovascular Medicine Karen Bouchard, Peter P. Liu and Heather Tulloch Karen BouchardKaren Bouchard University of Ottawa Heart Institute, Canada (K.B., P.P.L., H.T.). University of Ottawa, Canada (K.B., P.P.L., H.T.). Search for more papers by this author , Peter P. LiuPeter P. Liu https://orcid.org/0000-0002-3017-1199 University of Ottawa Heart Institute, Canada (K.B., P.P.L., H.T.). University of Ottawa, Canada (K.B., P.P.L., H.T.). Search for more papers by this author and Heather TullochHeather Tulloch Correspondence to: Heather Tulloch, PhD, C. Psych, Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada, K1Y 4W7. Email E-mail Address: [email protected] University of Ottawa Heart Institute, Canada (K.B., P.P.L., H.T.). University of Ottawa, Canada (K.B., P.P.L., H.T.). Search for more papers by this author Originally published25 Apr 2022https://doi.org/10.1161/CIRCULATIONAHA.121.057629Circulation. 2022;145:1291–1293Cardiovascular care centers around the world struggle to keep pace with an aging population with complex medical needs, the requirement for physical distancing, and limited hospital resources rerouted to the acute management of COVID-19. The need for innovative, efficient, and efficacious virtual care systems is now more important than ever. Social robots (SRs) may rise to the challenge.SRs are artificial agents physically embodied with human or animal features and imbued with social and emotional intelligence.1 In health care applications, SRs act as a social companion and medical assistant to patients who have limited access to health care or home support services, those who are reticent to onsite hospital visits, or who require frequent follow-ups with health care providers. SRs are equipped with artificial intelligence technology that allows the system to mimic patient-provider encounters, such as recognizing voices, providing eye contact, interpreting and responding appropriately to verbal and nonverbal cues, and adapting to the user’s feedback, technology that has been leveraged to help the SR facilitate the detection of important changes in patients’ behavior and health status. Today, SRs predominantly supplement gerontological services in patients’ and long-term care homes, providing cognitive and social stimulation, supporting medication management, assisting with daily living tasks, and facilitating communication with the appropriate care provider or emergency responder. Recent iterations are now capable of screening for specific health conditions, including alcoholism and prediabetes, while embedded technologies, such as sensors, cameras, and processors, are used to collect pertinent, real-time data that supplement or replace physical examinations.Accumulating evidence indicates that SRs are adept at conducting physical rehabilitation and neuropsychiatric, psychosocial, and behavior-change interventions. Although not yet deployed on a large scale in cardiovascular medicine, SR interventions are linked to the reduction of surrogate risk factors associated with the progression of established cardiovascular disease among aging patients. For example, SR interventions have led to increased adherence to exercise regimes, improved medication compliance, reductions in snack episodes, weight loss, and decreased levels of loneliness.2 Improved oxygenation levels, reduced pulse rate, pulse oximetry, saliva cortisol, systolic and diastolic blood pressure, and galvanic skin response have also been observed across randomized controlled trials. These positive changes in cardiovascular reactivity parameters indicate that SRs may be particularly proficient at reducing users’ psychological distress, a cardiovascular disease risk factor that has been robustly linked to poor prognosis and subsequent cardiac events, in particular, among women. Positive effects have been noted in comparison with usual care, and clinician-led interventions, as well, which provide evidence that SRs may effectively supplement (or even substitute) treatments used in routine clinical practice. There is emerging evidence that SRs may also help to reduce hospital admissions and the workload of health care providers. To date, only 2 SR randomized controlled trials have been conducted with a sample of patients with cardiovascular disease. Higher exercise and cardiac rehabilitation adherence were observed among patients enrolled in a SR intervention versus usual care, albeit with small sample sizes (Ns <28).3It is possible that SRs may mitigate the identified challenges of remote patient monitoring in cardiovascular care,4 such as low patient engagement and patient-provider depersonalization, and may become a particularly efficacious virtual care tool. SRs stimulate increased patient interaction, elicit higher levels of satisfaction, and improve performance on tasks in comparison with other remote patient-monitoring devices (eg, smart watches, digital blood pressure monitors, fitness trackers, medical alert systems, and continuous glucose monitors). The comparative efficacy of SRs over remote patient-monitoring devices in a cardiovascular disease context is currently unknown, but data will soon accumulate because social robotics companies have recently partnered with health care organizations and pharmaceutical companies, including the American Heart Association and Pfizer, to develop SRs with evidence-based educational content.Despite these promising results, the integration of social robotics within cardiovascular medicine requires careful due diligence. Acquiring a SR is financially prohibitive for the individual patient, and it is unclear whether or how much health care systems would support the acquisition of a SR on behalf of the patient. The most widely distributed humanoid SR on the market costs customers an average of US $17 000 per unit, and a smaller, nonhumanoid robot designed to provide animal-like therapy costs users approximately US $9000. The costs of common remote patient-monitoring technologies vary widely but typically range lower (approximately US $100 to US $7000) than most SRs on the market. It remains to be seen whether SRs could reduce health care use on a larger scale, in particular, hospital admissions, similar to other virtual care programs rising throughout the pandemic. There would be substantial responsibility placed on health care and informational technology staff to become adequately trained in the SR’s accompanying software, to have the requisite resources to mine, verify, and protect the data in a way that is clinically useful, and to maintain the devices. Despite substantial progress in payment models adapting to virtual care during the course of the pandemic, it is unclear how a fee-for-service system would factor in the cost of SRs. The adoption of SRs would require substantial workflow reconfiguration and the cardiovascular services that could be supplemented or outright substituted by the robot remain to be identified as do policies for protecting providers’ job security and remuneration. Potential patient and provider hesitancy would also need to be addressed. Preliminary evidence indicates that 75% of patients reported a positive perception after interacting with a SR as part of an onsite cardiac rehabilitation program. The acceptability of SRs in health care, more broadly, currently hover ≈50%, with great variability across users’ age, sex or gender, culture, and health status or provider role, and robot design and capabilities, as well.5Under the landscape of the COVID-19 pandemic, the integration of SRs into cardiovascular medicine is ineluctable and replete with possibilities, but these complex systems will test health care systems, policy developers, researchers, and providers and patients alike. Steps that must be taken today to prepare for this next wave of virtual care are as follows: (1) Partnerships among cardiovascular and social robotics researchers and health technology industry leaders are required to expand research beyond pilot trials with small sample sizes and optimize SR efficiencies for managing cardiovascular disease while protecting patients’ and providers’ best interests. Robust experimental studies in cardiovascular medicine are urgently needed to elucidate the diagnostic groups that benefit the most from SR interventions and the systems and capabilities that derive the highest clinical value and the most reduction in health care costs related to hospital admissions and workflow reconfiguration. (2) Guidelines for the integration of remote patient monitoring technologies have been developed by the American Heart Association, but specific policies governing the use of SRs will need to be established. (3) Issues of privacy (both physical and informational), data ownership and security, and steps to prevent and respond to data breaches or misuse will need to be carefully considered before implementation. (4) Specialized medical training and professional development courses ought to examine emerging virtual care tools, such as SRs, and include course content that explores the potential ramifications of such tools on individual, interpersonal, and system levels. Health care leaders and practitioners that lean into the rapid advancement of social robotics will be better equipped to deal with the challenges of developing systems that are safe, accessible, equitable, ethical, and effective for patients, while still maintaining high-quality care.Article InformationAcknowledgmentsThe authors sincerely thank Dr Kerstin Dautenhahn and Dr Moojan Ghafurian for sharing their expertise on social robots and for their insightful comments on earlier versions of the article.Sources of FundingNone.Disclosures None.FootnotesCirculation is available at www.ahajournals.org/journal/circThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 1292.Correspondence to: Heather Tulloch, PhD, C. Psych, Prevention and Rehabilitation Center, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada, K1Y 4W7. Email [email protected]caReferences1. Breazeal C, Dautenhahn K, Kanda T. Social robotics. In: Siciliano B, Khatib O, eds. Springer Handbook of Robotics. 2016:1935–1972.CrossrefGoogle Scholar2. Pu L, Moyle W, Jones C, Todorovic M. The effectiveness of social robots for older adults: a systematic review and meta-analysis of randomized controlled studies.Gerontologist. 2019; 59:e37–e51. doi: 10.1093/geront/gny046CrossrefMedlineGoogle Scholar3. Céspedes N, Irfan B, Senft E, Cifuentes CA, Gutierrez LF, Rincon-Roncancio M, Belpaeme T, Múnera M. A socially assistive robot for long-term cardiac rehabilitation in the real world.Front Neurorobot. 2021; 15:633248. doi: 10.3389/fnbot.2021.633248CrossrefMedlineGoogle Scholar4. Mecklai K, Smith N, Stern AD, Kramer DB. Remote patient monitoring — overdue or overused?N Engl J Med. 2021; 384:1384–1386.doi: 10.1056/NEJMp2033275CrossrefMedlineGoogle Scholar5. Naneva S, Sarda Gou M, Webb TL, Prescott TJ. A systematic review of attitudes, anxiety, acceptance, and trust towards social robots.Int J Soc Robot. 2020; 12:1179–1201.CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails April 26, 2022Vol 145, Issue 17 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.121.057629PMID: 35467957 Originally publishedApril 25, 2022 Keywordscardiac rehabilitationartificial intelligenceroboticsPDF download Advertisement SubjectsAgingCardiovascular DiseaseDigital Health