Abstract 13: Consistent Remote Monitoring of Patients With Heart Failure Using Epxheartfailure: A Telemedicine Tool
Authors: Banna Soumya , Landon Megan L , Shivakumar Nishkala , Xu Catherine , Patel Kunjan , Sink Eric , Peters Robert , Javaherian Kavon , Blanchard Melvin , Ross Will , Ewald Gregory , Aung Wint Y 
Published: March 2022

Introduction:
Heart failure (HF) is among the most common reasons for hospital admissions, presenting a significant cost burden to the medical system. Patients are monitored at the hospital but often go home without enough long-term management. Chronic care involving consistent symptom monitoring and patient-provider communication is essential to HF management. Though careful management can improve patient quality of life and reduce hospital readmission costs, it may be time consuming and expensive. To address this, we created a SMS text-based platform, EpxHeartFailure (EpxHF), which allows for remote patient monitoring. Our novel platform seeks to improve chronic care management by simplifying patient self-care and patient-provider communication. The goal of this low-cost intervention is to gain patient and provider acceptability and improve patient symptom stability.

Methods:
We conducted a retrospective review of a commercial implementation of EpxHF. Data was collected from patients over a 30-week trial period. EpxHF prompted patients to self-report body weight and symptoms of dyspnea/pedal edema (DPE), orthopnea, and edema compared to the previous day. Weight gain (>5lbs over 1 week) plus 1 other worsening symptom triggered an alert (text or call) to the patient’s provider. Providers could then contact the patient and initiate follow up care. The intervention modified message frequency to parallel each patient’s symptom stability and sent providers bimonthly triaged reports that prioritized the most unstable patients. Patients were also asked a question adapted from Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess quality of life and how often a patient’s symptoms interfere with daily functioning (0 - never, 5- all the time).

Results:
One-hundred seventy patients in St. Louis were enrolled onto EpxHF at hospitals using care managers within risk sharing and capacitated value models. A total of 3244 texts were sent, 87 alerts were generated, and 99 communications between providers and patients were documented following alerts. The average patient engagement rate was 81%, indicating acceptability. Normalized data for DPE, orthopnea, and excessive weight gain on a scale of -1 to +1 (+1 representing symptom improvement, 0 no change, -1 worsening symptoms) indicated a clear trend of improvement on a weekly basis (avg for all patients: 0.24 DPE, 0.21 orthopnea, 0.07 excessive weight gain). At week 30, the average KCCQ score decreased by 1.38 from baseline (95% CI: 1.299-1.467), which indicates an increase in perceived quality of life.

Discussion:
The results demonstrate the ability of the system to engage patients, track their symptomatology and improve quality of life. EpxHF is a cost-effective tool that uses basic texting technology to help providers monitor HF patient’s fluctuating symptoms, with the goal of enabling medical intervention before a HF exacerbation occurs.