Analysis and design of solutions using ambulatory monitoring devices for the diagnosis and management of cardiac patients.

Europe is undergoing mayor demographic changes; life expectancy is increasing due to lower mortality and birth rates. This ageing of the population is impacting directly on health. Chronic processes are increasing at unsustainable rates and healthcare systems are
demanding a full transformation. Cardiology is one of the most demanding services, cardiovascular diseases are the first cause of death in the Spanish population and will be the focus area of this work.

Technology has been evolving quickly, and the healthcare sector is also shifting towards this tendency. But not only technological development will save healthcare systems from unsustainability. One of the most promising applications is the redesign of clinical processes and technology to increase the value of healthcare through services.

The objective of this work is the analysis and design of solutions using ambulatory monitoring devices for the diagnosis and management of cardiac patients. Different use cases were defined, and the early identification of cardiac arrhythmias and the follow-up of post-acute heart failure patients were developed as a first approach.

Remote patient monitoring is a service that has encountered good results in evidence. The creation of a Support Center for Remote Monitoring for the diagnosis of cardiac arrhythmias and the follow-up of patients with heart failure in a similar way that occurs in other fields of cardiology (such as the pacemakers one) for a hospital or net of hospitals could improve significantly efficiency, reduce variability, normalize processes and help reduce the actual barriers for the rest of hospitals to adopt these technologies.

Ambulatory ECG devices are a fundamental part of the solution. This field has also followed a spiraling development, however their implementation in daily clinical practice is still constrained. A deep analysis on these technologies and the election of one of the devices for
evaluation was key for building up the protocols and end up with two proposals that will be evaluated in two pilot projects in a hospital in Madrid.

Finally, this work wanted to keep the focus on value-based health care, measuring outcomes that matter to patients as well as generating a high-level “pay for value not for volume” reimbursement model.