Study Uses Digital Equipment to Monitor Heart Patients at Home

By David Robinson

The 62-year-old Sherwood resident is doing what he can to continue beating the odds since a simultaneous heart attack and stroke brought him to UAMS five years ago.

Bruno is one of about 438,000 heart failure survivors in Arkansas. Nearly a quarter will die in one year and nearly half in five years after their first hospitalization. Most struggle daily.

“There’s really nothing worse,” said UAMS’ Leanne Lefler, Ph.D., APRN, who cared for heart failure patients for 17 years. “They live with fear, frustration and distress every day because of recurrent symptoms.”

Lefler has been working to improve their lives her whole career. Now, as a researcher, she is on the cusp of doing it in a big way.

She successfully tested daily digital home-health monitoring by UAMS in a small study that included Bruno as a participant. That work led to a three-year, $4 million Patient-Centered Outcomes Research Institute (PCORI) award in December 2019. It is the largest research grant ever awarded to the UAMS College of Nursing.

The PCORI study focuses on the heart failure patients’ key health measures – weight, blood pressure and blood oxygen level. The patients take measurements every day and submit them electronically to the UAMS Call Center, where registered nurses are monitoring them. If a patient forgets or if their numbers show signs of trouble, they can expect a phone call.

The study will involve 400 patients hospitalized at UAMS with heart failure. Half will be connected to UAMS by Wi-Fi. The other half will take the same measurements at home but without the remote monitoring connection with UAMS. Low-income participants will be provided limited Wi-Fi, and all patients will receive monitoring equipment.

Survivors of heart failure leave the hospital with special instructions and an average of 11 prescription medications per day, requiring complex regimens. They are often older and lack the ability to do it all. Rural and poorer patients with heart failure have the worst outcomes.

Bruno, now part of a patient advisory board for the PCORI study, sees exciting potential for the digital intervention.

“Having that connection with UAMS will be a great help, especially in rural areas,” Bruno said. “When I was in Dr. Lefler’s pilot study, it really helped me stay on top of my numbers and get into the routine of managing my own care.”

The digital intervention was designed with assistance by the patient advisory board, and collaborators such as the UAMS Institute for Digital Health & Innovation, the Arkansas Center for Health Improvement, the Arkansas Foundation for Medical Care and the Arkansas affiliate of the American Heart Association.

Lefler believes the study will show that digital health can improve patient self-care, reduce hospital readmissions, lower mortality and increase quality of life. If it can do all that, it will significantly reduce costs. That, in turn, could mean a continuation of no-cost Wi-Fi and monitoring equipment for Medicare and Medicaid patients.

“UAMS believes in equity, decreasing health disparities, and outreach to rural areas,” Lefler said. “This study is helping to develop and test a model of care that is sustainable beyond the grant funding and applicable to hospital systems throughout the U.S.”

  • Heart disease is the leading cause of death in the United States.
  • Heart disease killed 8,171 Arkansans in 2018.
  • Arkansas has the 4th highest rate of heart-related deaths in the U.S.