ISSN 1671-5411 CN 11-5329/R
Volume 18 Issue 9
Sep.  2021
Turn off MathJax
Article Contents
Please cite this article as: Jamal NE, Abi-Saleh B, Isma’eel H. Advances in telemedicine for the management of the elderly cardiac patient. J Geriatr Cardiol 2021; 18(9): 759−767. DOI: 10.11909/j.issn.1671-5411.2021.09.004
Citation: Please cite this article as: Jamal NE, Abi-Saleh B, Isma’eel H. Advances in telemedicine for the management of the elderly cardiac patient. J Geriatr Cardiol 2021; 18(9): 759−767. DOI: 10.11909/j.issn.1671-5411.2021.09.004

Advances in telemedicine for the management of the elderly cardiac patient

doi: 10.11909/j.issn.1671-5411.2021.09.004
More Information
  • Corresponding author:
  • Available Online: 2021-08-20
  • Publish Date: 2021-09-30
  • Telemedicine is the use of information and communication technology to deliver healthcare at a distance. It has been resorted to during the COVID-19 pandemic to lessen the need for in-person patient care decreasing the risk of transmission, and it can be of benefit afterward in the management of cardiac disease. The elderly population has unique challenges concerning the use of telehealth technologies. We thus review the advances in telemedicine technologies in treating elderly cardiac patients including in our discussion only studies with a mean age of participants above 60. Remote monitoring of blood pressure, weight, and symptoms, along with home ECG recording has been found to be superior to usual in-clinic follow up. Combining remote monitoring with video conferencing with physicians, patient education websites, and applications is also of benefit. Remote monitoring of Implantable Cardioverter Defibrillators (ICD) and Cardiac Resynchronization Therapy Defibrillators (CRT-D) is also beneficial but can be at the cost of an increase in both appropriate and inappropriate interventions. Implantable sensing devices compatible with remote monitoring have been developed and have been shown to improve care and cost-effectiveness. New smartphone software can detect arrhythmias using home ECG recordings and can detect atrial fibrillation using smartphone cameras. Remote monitoring of implanted pacemakers has shown non-inferiority to in clinic follow up. On the other hand, small-scale questionnaire-based studies demonstrated the willingness of the elderly cardiac patients to use such technologies, and their satisfaction with their use and ease of use. Large-scale studies should further investigate useability in samples more representative of the general elderly population with more diverse socioeconomic and educational backgrounds. Accordingly, it seems that studying integrating multiple technologies into telehealth programs is of great value. Further efforts should also be put in validating the technologies for specific diseases along with the legal and reimbursement aspects of the use of telehealth.
  • loading
  • [1]
    World Health Organization. Telemedicine, opporunities and developments in member states 2010.
    Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health 2020; 20: 1193. doi: 10.1186/s12889-020-09301-4
    AMA Telehealth quick guide. (Accessed November 24 2020).
    Byambasuren O, Beller E, Glasziou P. Current knowledge and adoption of mobile health apps among australian general practitioners: survey Study. JMIR Mhealth Uhealth 2019; 7: e13199. doi: 10.2196/13199
    Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020; 324: 782−793. doi: 10.1001/jama.2020.12839
    Inciardi RM, Adamo M, Lupi L, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J 2020; 41: 1821−1829. doi: 10.1093/eurheartj/ehaa388
    Foster MV, Sethares KA. Facilitators and barriers to the adoption of telehealth in older adults: an integrative review. Comput Inform Nurs 2014; 32: 523−533. doi: 10.1097/CIN.0000000000000105
    Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics--2016 update: a report from the American Heart Association. Circulation 2016; 133: 447−454. doi: 10.1161/CIR.0000000000000366
    Azad N, Lemay G. Management of chronic heart failure in the older population. J Geriatr Cardiol 2014; 11: 329−337.
    Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the management of heart failure. J Am Coll Cardiol 2013; 62: e147−e239. doi: 10.1016/j.jacc.2013.05.019
    Pandor A, Thokala P, Gomersall T, et al. Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation. Health Technol Assess 2013; 17: 1−207, v-vi.
    Cleland JG, Louis AA, Rigby AS, et al. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 2005; 45: 1654−1664. doi: 10.1016/j.jacc.2005.01.050
    Koehler F, Koehler K, Deckwart O, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018; 392: 1047−1057. doi: 10.1016/S0140-6736(18)31880-4
    Mockel M, Koehler K, Anker SD, et al. Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM-HF2 trial. Eur J Heart Fail 2019; 21: 1445−1458. doi: 10.1002/ejhf.1530
    Grustam AS, Severens JL, De Massari D, et al. Cost-Effectiveness analysis in telehealth: a comparison between home telemonitoring, nurse telephone support, and usual care in chronic heart failure management. Value Health 2018; 21: 772−782. doi: 10.1016/j.jval.2017.11.011
    Jimenez-Marrero S, Yun S, Cainzos-Achirica M, et al. Impact of telemedicine on the clinical outcomes and healthcare costs of patients with chronic heart failure and mid-range or preserved ejection fraction managed in a multidisciplinary chronic heart failure programme: A sub-analysis of the iCOR randomized trial. J Telemed Telecare 2020; 26: 64−72. doi: 10.1177/1357633X18796439
    Bauce K, Fahs DB, Batten J, Whittemore R. Videoconferencing for management of heart failure: an integrative review. J Gerontol Nurs 2018; 44: 45−52.
    Wagenaar KP, Broekhuizen BDL, Jaarsma T, et al. Effectiveness of the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters. org’ and an e-health adjusted care pathway in patients with stable heart failure: results of the ‘e-Vita HF’ randomized controlled trial. Eur J Heart Fail 2019; 21: 238−246. doi: 10.1002/ejhf.1354
    Bogyi P, Vamos M, Bari Z, et al. Association of remote monitoring with survival in heart failure patients undergoing cardiac resynchronization therapy: retrospective observational study. J Med Internet Res 2019; 21: e14142. doi: 10.2196/14142
    Geller JC, Lewalter T, Bruun NE, et al. Implant-based multi-parameter telemonitoring of patients with heart failure and a defibrillator with vs. without cardiac resynchronization therapy option: a subanalysis of the IN-TIME trial. Clin Res Cardiol 2019; 108: 1117−1127. doi: 10.1007/s00392-019-01447-5
    Tajstra M, Kurek A, Pyka L, Gasior M. The increased rate of life-threatening interventions in remotely monitored patients with heart failure during the coronavirus disease 2019 pandemic. Pol Arch Intern Med 2020; 130: 913−914.
    D’Amario D, Restivo A, Canonico F, et al. Experience of remote cardiac care during the COVID-19 pandemic: the V-LAP device in advanced heart failure. Eur J Heart Fail 2020; 22: 1050−1052. doi: 10.1002/ejhf.1900
    Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377: 658−666. doi: 10.1016/S0140-6736(11)60101-3
    Abraham WT, Stevenson LW, Bourge RC, et al. Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet 2016; 387: 453−461. doi: 10.1016/S0140-6736(15)00723-0
    Nakayama A, Takayama N, Kobayashi M, et al. Remote cardiac rehabilitation is a good alternative of outpatient cardiac rehabilitation in the COVID-19 era. Environ Health Prev Med 2020; 25: 48. doi: 10.1186/s12199-020-00885-2
    Hwang R, Morris NR, Mandrusiak A, et al. Cost-utility analysis of home-based telerehabilitation compared with centre-based rehabilitation in patients with heart failure. Heart Lung Circ 2019; 28: 1795−1803. doi: 10.1016/j.hlc.2018.11.010
    Peng X, Su Y, Hu Z, et al. Home-based telehealth exercise training program in Chinese patients with heart failure: A randomized controlled trial. Medicine (Baltimore) 2018; 97: e12069. doi: 10.1097/MD.0000000000012069
    Guo Y, Lane DA, Wang L, et al. Mobile Health (mHealth) technology for improved screening, patient involvement and optimising integrated care in atrial fibrillation: The mAFA (mAF-App) II randomised trial. Int J Clin Pract 2019; 73: e13352.
    Steinhubl SR, Waalen J, Edwards AM, et al. Effect of a home-based wearable continuous ECG Monitoring patch on detection of undiagnosed atrial fibrillation: The mSToPS Randomized Clinical Trial. JAMA 2018; 320: 146−155. doi: 10.1001/jama.2018.8102
    Mena LJ, Felix VG, Ochoa A, et al. Mobile personal health monitoring for automated classification of electrocardiogram signals in elderly. Comput Math Methods Med 2018; 2018: 9128054.
    Busch MC, Gross S, Alte D, et al. Impact of atrial fibrillation detected by extended monitoring-A population-based cohort study. Ann Noninvasive Electrocardiol 2017: 22.
    Brasier N, Raichle CJ, Dorr M, et al. Detection of atrial fibrillation with a smartphone camera: first prospective, international, two-centre, clinical validation study (DETECT AF PRO). Europace 2019; 21: 41−47. doi: 10.1093/europace/euy176
    Guo Y, Wang H, Zhang H, et al. Mobile photoplethysmographic technology to detect atrial fibrillation. J Am Coll Cardiol 2019; 74: 2365−2375. doi: 10.1016/j.jacc.2019.08.019
    Perez MV, Mahaffey KW, Hedlin H, et al. Large-scale assessment of a smartwatch to identify atrial fibrillation. N Engl J Med 2019; 381: 1909−1917. doi: 10.1056/NEJMoa1901183
    Manimaran M, Das D, Martinez P, et al. The impact of virtual arrhythmia clinics following catheter ablation for atrial fibrillation. Eur Heart J Qual Care Clin Outcomes 2019; 5: 272−273. doi: 10.1093/ehjqcco/qcz011
    Guo Y, Chen Y, Lane DA, et al. Mobile health technology for atrial fibrillation management integrating decision support, education, and patient involvement: mAF App Trial. Am J Med 2017; 130: 1388−96 e6. doi: 10.1016/j.amjmed.2017.07.003
    Guo Y, Lane DA, Wang L, et al. Mobile health technology to improve care for patients with atrial fibrillation. J Am Coll Cardiol 2020; 75: 1523−1534.
    Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2013; 34: 2281−329. doi: 10.1093/eurheartj/eht150
    Slotwiner D, Varma N, Akar JG, et al. HRS expert consensus statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm 2015; 12: e69−e100. doi: 10.1016/j.hrthm.2015.05.008
    Parahuleva MS, Soydan N, Divchev D, et al. Home monitoring after ambulatory implanted primary cardiac implantable electronic devices: The home ambulance pilot study. Clin Cardiol 2017; 40: 1068−1075. doi: 10.1002/clc.22772
    Watanabe E, Yamazaki F, Goto T, et al. Remote management of pacemaker patients with biennial in-clinic evaluation: continuous home monitoring in the Japanese At-Home Study: A Randomized Clinical Trial. Circ Arrhythm Electrophysiol 2020; 13: e007734.
    Lopez-Liria R, Lopez-Villegas A, et al. Telemonitoring and Quality of Life in Patients after 12 Months Following a Pacemaker Implant: the Nordland Study, a Randomised Trial. Int J Environ Res Public Health 2019; 16: 2001.
    Venkatesh V, Thong JY, Xu X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. MIS Quarterly 2012; 36: 157−178.
    Woo K, Dowding DW. Decision-making factors associated with telehealth adoption by patients with heart failure at home: a qualitative study. Comput Inform Nurs 2020; 38: 204−214. doi: 10.1097/CIN.0000000000000589
    Jaana M, Sherrard H, Pare G. A prospective evaluation of telemonitoring use by seniors with chronic heart failure: Adoption, self-care, and empowerment. Health Informatics J 2019; 25: 1800−1814. doi: 10.1177/1460458218799458
    Guo X, Gu X, Jiang J, et al. A hospital-community-family-based telehealth program for patients with chronic heart failure: single-arm, prospective feasibility study. JMIR Mhealth Uhealth 2019; 7: e13229. doi: 10.2196/13229
    Timmermans I, Meine M, Szendey I, et al. Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow-up. Pacing Clin Electrophysiol 2019; 42: 120−129. doi: 10.1111/pace.13574
    Triantafyllidis A, Velardo C, Chantler T, et al. A personalised mobile-based home monitoring system for heart failure: The SUPPORT-HF Study. Int J Med Inform 2015; 84: 743−753. doi: 10.1016/j.ijmedinf.2015.05.003
    Ware P, Dorai M, Ross HJ, et al. Patient adherence to a mobile phone-based heart failure telemonitoring program: a longitudinal mixed-methods study. JMIR Mhealth Uhealth 2019; 7: e13259. doi: 10.2196/13259
    Rush KL, Hatt L, Gorman N, et al. Planning telehealth for older adults with atrial fibrillation in rural communities: understanding stakeholder perspectives. Clin Nurs Res 2019; 28: 130−149. doi: 10.1177/1054773818758170
    Hu PT, Hilow H, Patel D, et al. Use of virtual visits for the care of the arrhythmia patient. Heart Rhythm 2020; 17: 1779−1783. doi: 10.1016/j.hrthm.2020.05.011
    Lam K, Lu AD, Shi Y, Covinsky KE. Assessing telemedicine unreadiness among older adults in the united states during the COVID-19 pandemic. JAMA Intern Med 2020; 180: 1389−1391. doi: 10.1001/jamainternmed.2020.2671
    Scott Kruse C, Karem P, Shifflett K, et al. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018; 24: 4−12. doi: 10.1177/1357633X16674087
    Nielsen JC, Kautzner J, Casado-Arroyo R, et al. Remote monitoring of cardiac implanted electronic devices: legal requirements and ethical principles-ESC Regulatory Affairs Committee/EHRA joint task force report. Europace 2020; 22: 1742−1758. doi: 10.1093/europace/euaa168
    Tarakji KG, Silva J, Chen LY, et al. Digital health and the care of the patient with arrhythmia: what every electrophysiologist needs to know. Circ Arrhythm Electrophysiol 2020; 13: e007953.
    Gorodeski EZ, Goyal P, Cox ZL, et al. Virtual visits for care of patients with heart failure in the era of COVID-19: a statement from the Heart Failure Society of America. J Card Fail 2020; 26: 448−456. doi: 10.1016/j.cardfail.2020.04.008
    Telemedicine and Reimbursements: Preparing for Virtual Care in a Post-Pandemic World. 2021. (accessed on January 26, 2021).
    Fragasso G, Cuko A, Spoladore R, et al. Validation of remote cardiopulmonary examination in patients with heart failure with a videophone-based system. J Card Fail 2007; 13: 281−286. doi: 10.1016/j.cardfail.2007.01.008
    The ‘Steth IO’ Case Works in the Same Way as Medical Stethoscopes. 2017. (accessed on February 2, 2021).
  • 加载中


    通讯作者: 陈斌,
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(2)

    Article Metrics

    Article views (486) PDF downloads(75) Cited by()
    Proportional views


    DownLoad:  Full-Size Img  PowerPoint