Heart failure care is complex. It requires constant monitoring and managing, so it’s understandable that a major goal of any heart failure therapy is early recognition of deterioration. Digital therapeutics makes early detection possible, but how?
In an interview for The Sidebar, Bronwyn Hemus interviews Gudbjorg Gudlaugsdottir, a heart failure nurse in the heart failure outpatient clinic at the National Hospital of Iceland. Gudbjorg was able to detect the rapid deterioration of her heart failure patient through the Sidekick platform, leading to early intervention and treatment.
Your heart failure patient lived hours away from the hospital where you work. What made you decide to recommend Sidekick to her?
COVID had just anchored itself in Iceland, so we were in lockdown, making treatment and testing a lot more difficult to plan. This particular patient lived in the countryside, and she was recently diagnosed with severe heart failure. We knew she needed a treatment plan immediately, and usually we would require more tests like a coronary angiography, MRI, etc. to fully understand the severity of the condition, but at the time it was not possible for this patient. So remote monitoring was a necessity, especially because of her location.
I was already familiar with Sidekick, and I knew that even though it can’t replace a visit to the clinic, it was a good option for her. She was very open to using the app and took to it quickly.
You were remotely monitoring the patient as she was completing her daily PROs, at what point did you become concerned about her well-being?
The app made it possible for me to have regular contact with her and to keep an eye on how she was doing. She completed daily PROs and was able to send me messages and updates as well. I was concerned about her condition so having this contact made a difference.
I was regularly in contact with her, and she sent me daily messages about her symptoms. When she was going on a trip in the countryside, I made her promise to let me know if her symptoms would worsen.
She had been using the app for about two weeks, when one day, we were communicating through the Sidekick message center, and I could detect from her PROs that her symptoms weren’t good. She had difficulty breathing, she was tired, and had heaviness in her chest. I had a bad feeling about this and told her that she needed to go directly to the hospital where she was located or come to the hospital in Reykjavik as soon as possible. We agreed that she would fly in first thing the following morning, and in the meantime, I would prepare for her admission to the Cardiology unit.
You were able to detect a change in her state through the data generated by the app, and take measures to help her. What do you think might have happened if you weren’t able to remotely monitor her in this way?
Sidekick made it possible for us to have regular contact. I was also able to monitor her condition through the daily PROs. She was also able to message me every day and I could respond promptly. This level of communication and monitoring made it possible for our team to adjust her medication and make other suggestions before we saw each other.
The daily information on how her symptoms were developing and the regular contact helped me decide that she needed to be admitted to hospital straight away. While in the hospital, we were able to run tests and eventually fit her with a special heart failure pacemaker. I was also able to remotely monitor her through the app after she was discharged which gave us comfort as she needed to be watched closely.
Can you tell us how you were able to see the change in patterns in the data?
It all came down to her symptoms. Her PROs and her messages made me realize quite quickly that something was wrong. At this stage, we didn’t know what the cause of her heart failure was, so I was worried about her.
How does this make you feel about the potential of digital therapeutics as a solution to improving patient well-being and outcomes?
One thing is the convenience of the app. Patients don’t have to come in so regularly for check-ups or tests, and their daily PROs can be done from their homes or wherever they are. This line of communication gives patients peace of mind that they are being monitored. It’s a win-win as it means the clinic’s resources and staff are freed up to focus on the patients who need us the most.
Everyone is busy, of course, and sometimes we end up spending longer than we plan to on minor situations or less severe cases. They shouldn’t take so long, but they do. Sidekick gives us more space and time, making it possible to prioritize and focus on very sick patients.
Sidekick makes it possible for patients to have regular access to us and we have more direct contact with them, and can help and advise them in real-time, like adjusting medication, or even telling them to not eat a specific salty food that they may have logged in the app.
From a patient perspective, Sidekick has the possibility to empower people in their self-care and to make important changes in their lifestyle. I have had many patients use the app and overall, they did well: they lost weight, exercised more, and were more aware of their health and well-being. The videos in the app are inspirational and give patients new ideas on how to take care of themselves, how to exercise, what to eat, how to meditate and so on – the patients get a lot out of this, and it’s encouraging for them.
One of our middle-aged patients with very serious heart failure enjoyed being in the mountains and riding motorbikes. His condition was difficult for him because he did not want to accept this change in his life. But Sidekick was wonderful for him as he used the meditation and relaxation training every day and was able to find some kind of peace with his life.