- Email: [email protected]
Telemonitoring atrial fibrillation: Feasibility study and results of 130 patients
6e Congrès européen de l’ANTEL, Paris novembre 2013
36 cible tout ce que le patient perc ¸oit, ressent et connaît de lui-même et agit comme un support de la relation soignant-soigné. Créé par la société Actiset en 2011, Symptosite dispose aujourd’hui d’une large gamme d’outils de reporting qui offrent aux patients des supports de notation clairs et soutenants. Le clinicien prescrit depuis sa plateforme une notation à son patient comme par exemple un agenda du sommeil numérique, un suivi quotidien de l’humeur, des questionnaires validés. Une procédure d’anonymisation (validée par la CNIL) garantit la sécurité des données. Les données ainsi recueillies, sont compilées en fiches de synthèse enregistrables sur les progiciels. Ces outils sont rassemblés dans des modules correspondants aux grands thèmes cliniques : les troubles du sommeil, de l’humeur, des conduites alimentaires, la douleur, l’anxiété, l’asthme etc. Les modules en développement sont à l’essai en ‘‘living lab’’ dans des cabinets médicaux. Symptosite répond à trois axes forts. D’abord, le suivi des pathologies chroniques, en évaluant et réévaluant, si besoin, la clinique et la qualité de vie des patients. Déjà utilisable, Symptosite poursuit le développement du suivi du diabète et de l’insuffisance respiratoire. Deuxièmement, la télé-expertise. Par exemple, l’application est utilisée pour interroger des spécialistes en médecine du sommeil, via Internet, sur les cas prioritaires à leurs consultations. Leurs réponses se basent sur la fiche de synthèse Symptosite. Troisièmement, l’amélioration du parcours de soin. Depuis 2012, les psychiatres experts de l’Institut médico-chirurgical Lorrain de l’obésité, pour le bilan de chirurgie bariatrique utilisent Symptosite pour près de 300 patients par an. Depuis, la durée du bilan a diminué de 25 % et les délais d’accès à la consultation ont été réduits. Symptosite tire partie des nouvelles technologies pour être en phase avec les besoins de santé et rester en accord avec les pratiques cliniques. Il complète l’analyse des signes physiques, numérisés ou non, par le recueil des dimensions subjectives du symptôme. http://dx.doi.org/10.1016/j.eurtel.2014.01.004 3
Management of hypertension by telemedicine: Feasability study and results of 150 patients P. Dary 78500 Saint-Yrieix La Perche, France Purpose.— According to the results of the French national health study conducted from 2006 to 2007, the prevalence of hypertension in a population aged 18 to 74 years is estimated at 31%, of which 20% are untreated. Of the patients who are treated, 49% are not controlled. The aim of this observational study is to assess the feasibility of monitoring blood pressure by telemedicine in 150 hypertensive patients, in order to obtain a blood pressure profile and improve control by adapting the treatment in real time. Methods.— Monitoring blood pressure by telemedicine is carried out by the patients. Uncontrolled hypertensive patients self-measure six times daily. Follow-up is organized into three phases: inclusion, observation, treatment. Blood pressure is measured by oscillometry; results are transmitted directly and are available for consultation on a secure web site. Results.— Mean age is 65.5 years, 71 male and 79 female, 18% are untreated. The prevalence of atrial fibrillation is 22% and diabetes is 14%. Blood pressure at inclusion is 175/92. There were three groups comprising 32 patients with normal blood pressure (134/75) after 5.5 days of follow-up, a second group comprising 113 uncontrolled patients (164/86) who continue follow-up via telemedicine during the treatment phase and a third group of five patients who decided to stop the monitoring as they did not like taking the treatment (174/94). Treatment adaptation is achieved within 12 days with an average of 179/93 at inclusion, 164/86 during the observational phase and 144/78 after the last therapeutic adaptation (P < 0.0001). The
decrease in blood pressure between the two phases is 20 mmHG for systolic blood pressure and 8 mm for diastolic blood pressure. It is obtained by adding another drug (47%) or changing the therapeutic class (22%) with an increase in dosage. 42% achieve the objectives (< 141) and 54% remain with, on average, a systolic blood pressure of 153 systolic. Conclusions.— Telemedicine is a simple method for monitoring blood pressure allowing a rapid adaptation of treatment in order to improve blood pressure control. Telemedicine implies an active participation of the patient. http://dx.doi.org/10.1016/j.eurtel.2014.01.005 4
Telemonitoring atrial fibrillation: Feasibility study and results of 130 patients P. Dary 78500 Saint-Yrieix-La-Perche, France Objectives.— Atrial fibrillation (AF) increases the risk of having a stroke fivefold. This observational study of 130 patients evaluates the diagnostic and therapeutic benefit of telemonitoring by electrocardiogram (ECG) in an ‘‘at risk’’ population. Method.— Patients were enrolled either with symptoms of AF, with the aim of enhancing the sensitivity of detection, or with confirmed AF, with the aim of optimizing anti-arrhythmia (AA) and anticoagulant (AC) treatment. The patient self-monitors at home, via a holter worn for an average of ten hours per day, for 11 days. The arrhythmias are detected and the readings are automatically transmitted. Results.— One hundred and thirty patients: 49% men and 51% women, mean age of 65 years. 10% had already experienced a stroke. 28% presented with AF, 33% were taking an AA and 25% AC. For the 94 patients in sinus rhythm (72%), the monitoring lasted 11 days, 240 ECGs were transmitted (11 h/d) with an overall CHADSVasc score of 1.9. Changes involved an absence of abnormality (43%), an onset of AF (33%) and rise in number of patients taking AC from 35 to 58%, and AA from 32% to 71%, the discovery of regular tachycardia (24%) treated with HR control medications. For the 36 patients (28%) already diagnosed with an arrhythmia, telemonitoring was an alternative to hospitalisation. Follow-up lasted nine days, 276 ECG were transmitted (10 h/d), with a CHADSVasc score of 2.4. Initiation of AC rose rapidly from 30% to 89%. HR was controlled (59%), dropping from 100 to 77/min and monitoring for medications increasing from 14% to 70%. There was also a return to sinus rhythm (41%), demonstrating the effects of the increase in AA taken (22% to 81%). Conclusions.— Telemonitoring enables the diagnosis, monitoring and treatment of AF. Daily monitoring by ECG allows rapid introduction of AC treatment and improves the safety of AA and HR control medications as the dosages prescribed can be modified under real time conditions on the basis of heart rate and rhythm measurements and conduction times. http://dx.doi.org/10.1016/j.eurtel.2014.01.006 5
Télésurveillance dans l’insuffisance cardiaque : intérêt d’un suivi limité à 15 jours sur 60 patients P. Dary 78500 Saint-Yrieix-La-Perche, France Objectifs.— L’insuffisance cardiaque (IC) est un enjeu de santé publique, du fait de l’augmentation de son incidence liée au vieillissement de la population, la survie après infarctus et l’augmentation constante des hospitalisations. Cette étude observationnelle vise à évaluer, par le biais d’une télésurveillance,
36 cible tout ce que le patient perc ¸oit, ressent et connaît de lui-même et agit comme un support de la relation soignant-soigné. Créé par la société Actiset en 2011, Symptosite dispose aujourd’hui d’une large gamme d’outils de reporting qui offrent aux patients des supports de notation clairs et soutenants. Le clinicien prescrit depuis sa plateforme une notation à son patient comme par exemple un agenda du sommeil numérique, un suivi quotidien de l’humeur, des questionnaires validés. Une procédure d’anonymisation (validée par la CNIL) garantit la sécurité des données. Les données ainsi recueillies, sont compilées en fiches de synthèse enregistrables sur les progiciels. Ces outils sont rassemblés dans des modules correspondants aux grands thèmes cliniques : les troubles du sommeil, de l’humeur, des conduites alimentaires, la douleur, l’anxiété, l’asthme etc. Les modules en développement sont à l’essai en ‘‘living lab’’ dans des cabinets médicaux. Symptosite répond à trois axes forts. D’abord, le suivi des pathologies chroniques, en évaluant et réévaluant, si besoin, la clinique et la qualité de vie des patients. Déjà utilisable, Symptosite poursuit le développement du suivi du diabète et de l’insuffisance respiratoire. Deuxièmement, la télé-expertise. Par exemple, l’application est utilisée pour interroger des spécialistes en médecine du sommeil, via Internet, sur les cas prioritaires à leurs consultations. Leurs réponses se basent sur la fiche de synthèse Symptosite. Troisièmement, l’amélioration du parcours de soin. Depuis 2012, les psychiatres experts de l’Institut médico-chirurgical Lorrain de l’obésité, pour le bilan de chirurgie bariatrique utilisent Symptosite pour près de 300 patients par an. Depuis, la durée du bilan a diminué de 25 % et les délais d’accès à la consultation ont été réduits. Symptosite tire partie des nouvelles technologies pour être en phase avec les besoins de santé et rester en accord avec les pratiques cliniques. Il complète l’analyse des signes physiques, numérisés ou non, par le recueil des dimensions subjectives du symptôme. http://dx.doi.org/10.1016/j.eurtel.2014.01.004 3
Management of hypertension by telemedicine: Feasability study and results of 150 patients P. Dary 78500 Saint-Yrieix La Perche, France Purpose.— According to the results of the French national health study conducted from 2006 to 2007, the prevalence of hypertension in a population aged 18 to 74 years is estimated at 31%, of which 20% are untreated. Of the patients who are treated, 49% are not controlled. The aim of this observational study is to assess the feasibility of monitoring blood pressure by telemedicine in 150 hypertensive patients, in order to obtain a blood pressure profile and improve control by adapting the treatment in real time. Methods.— Monitoring blood pressure by telemedicine is carried out by the patients. Uncontrolled hypertensive patients self-measure six times daily. Follow-up is organized into three phases: inclusion, observation, treatment. Blood pressure is measured by oscillometry; results are transmitted directly and are available for consultation on a secure web site. Results.— Mean age is 65.5 years, 71 male and 79 female, 18% are untreated. The prevalence of atrial fibrillation is 22% and diabetes is 14%. Blood pressure at inclusion is 175/92. There were three groups comprising 32 patients with normal blood pressure (134/75) after 5.5 days of follow-up, a second group comprising 113 uncontrolled patients (164/86) who continue follow-up via telemedicine during the treatment phase and a third group of five patients who decided to stop the monitoring as they did not like taking the treatment (174/94). Treatment adaptation is achieved within 12 days with an average of 179/93 at inclusion, 164/86 during the observational phase and 144/78 after the last therapeutic adaptation (P < 0.0001). The
decrease in blood pressure between the two phases is 20 mmHG for systolic blood pressure and 8 mm for diastolic blood pressure. It is obtained by adding another drug (47%) or changing the therapeutic class (22%) with an increase in dosage. 42% achieve the objectives (< 141) and 54% remain with, on average, a systolic blood pressure of 153 systolic. Conclusions.— Telemedicine is a simple method for monitoring blood pressure allowing a rapid adaptation of treatment in order to improve blood pressure control. Telemedicine implies an active participation of the patient. http://dx.doi.org/10.1016/j.eurtel.2014.01.005 4
Telemonitoring atrial fibrillation: Feasibility study and results of 130 patients P. Dary 78500 Saint-Yrieix-La-Perche, France Objectives.— Atrial fibrillation (AF) increases the risk of having a stroke fivefold. This observational study of 130 patients evaluates the diagnostic and therapeutic benefit of telemonitoring by electrocardiogram (ECG) in an ‘‘at risk’’ population. Method.— Patients were enrolled either with symptoms of AF, with the aim of enhancing the sensitivity of detection, or with confirmed AF, with the aim of optimizing anti-arrhythmia (AA) and anticoagulant (AC) treatment. The patient self-monitors at home, via a holter worn for an average of ten hours per day, for 11 days. The arrhythmias are detected and the readings are automatically transmitted. Results.— One hundred and thirty patients: 49% men and 51% women, mean age of 65 years. 10% had already experienced a stroke. 28% presented with AF, 33% were taking an AA and 25% AC. For the 94 patients in sinus rhythm (72%), the monitoring lasted 11 days, 240 ECGs were transmitted (11 h/d) with an overall CHADSVasc score of 1.9. Changes involved an absence of abnormality (43%), an onset of AF (33%) and rise in number of patients taking AC from 35 to 58%, and AA from 32% to 71%, the discovery of regular tachycardia (24%) treated with HR control medications. For the 36 patients (28%) already diagnosed with an arrhythmia, telemonitoring was an alternative to hospitalisation. Follow-up lasted nine days, 276 ECG were transmitted (10 h/d), with a CHADSVasc score of 2.4. Initiation of AC rose rapidly from 30% to 89%. HR was controlled (59%), dropping from 100 to 77/min and monitoring for medications increasing from 14% to 70%. There was also a return to sinus rhythm (41%), demonstrating the effects of the increase in AA taken (22% to 81%). Conclusions.— Telemonitoring enables the diagnosis, monitoring and treatment of AF. Daily monitoring by ECG allows rapid introduction of AC treatment and improves the safety of AA and HR control medications as the dosages prescribed can be modified under real time conditions on the basis of heart rate and rhythm measurements and conduction times. http://dx.doi.org/10.1016/j.eurtel.2014.01.006 5
Télésurveillance dans l’insuffisance cardiaque : intérêt d’un suivi limité à 15 jours sur 60 patients P. Dary 78500 Saint-Yrieix-La-Perche, France Objectifs.— L’insuffisance cardiaque (IC) est un enjeu de santé publique, du fait de l’augmentation de son incidence liée au vieillissement de la population, la survie après infarctus et l’augmentation constante des hospitalisations. Cette étude observationnelle vise à évaluer, par le biais d’une télésurveillance,