AI in Germany
August 1, 2021
1818-1859
September 1, 2021Article of the Month – August 2021
Effect of Smartphone-Enabled Health Monitoring Devices vs Regular Follow-up on Blood Pressure Control Among Patients After Myocardial Infarction.
A Randomized Clinical Trial
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Importance
Smart technology via smartphone-compatible devices might improve blood pressure (BP) regulation in patients after a myocardial infarction.
Objectives
To investigate whether smart technology in clinical practice can improve BP regulation and to evaluate the feasibility of such an intervention.
Design, Setting & Participants
This study was an investigator-initiated, single-center, non-blinded, feasibility, randomized clinical trial conducted at the Department of Cardiology of the Leiden University Medical Center between May 2016 and December 2018. Two hundred patients admitted with either ST-segment elevation myocardial infarction or non–ST-segment acute coronary syndrome were randomized in a 1:1 fashion between follow-up groups using smart technology and regular care. Statistical analysis was performed from January 2019 to March 2019.
Interventions
Four physical outpatient clinic visits were scheduled in the year following the initial event for patients randomized to regular care. In the intervention group, patients were given four smartphone-compatible devices (weight scale, blood pressure (BP) monitor, rhythm monitor, and step counter). In addition, two in-person outpatient clinic visits were replaced by electronic visits.
Main Outcomes and Measures...
The primary outcome measured was BP control. The secondary was, as a parameter of feasibility, patient satisfaction (general questionnaire and smart technology–specific questionnaire), measurement adherence, all-cause mortality, and hospitalizations for nonfatal adverse cardiac events.
Results
In total, 200 patients (median age, 59.7 years [interquartile range, 52.9-65.6 years]; 156 men [78%]) were included, of whom 100 were randomized to the intervention group and 100 to the control group. After one year, 79% of patients in the intervention group had controlled BP vs. 76% of patients in the control group (P = .64). General satisfaction with care was the same between groups (mean [SD] scores, 82.6 [14.1] vs 82.0 [15.1]; P = .88). The all-cause mortality rate was 2% in both groups (P > .99). A total of 20 hospitalizations for nonfatal adverse cardiac events occurred (8 in the intervention group and 12 in the control group). Of all patients, 32% sent in measurements each week, with 63% sending data for more than 80% of the weeks they participated in the trial. In the intervention group only, 90.3% of patients were satisfied with the smart technology intervention.
Conclusions
These findings suggest that smart technology yields similar percentages of patients with regulated BP compared with the standard of care. Such an intervention is feasible in clinical practice and is accepted by patients. More research is mandatory to improve patient preference for such an intervention.
Relevance to Healthcare Field
Artificial intelligence (AI) uses algorithms and software to reproduce an analysis and interpretation of information without human contact. Considering the vast majority of Americans (96%) are smartphone users and the number of worldwide users today surpasses three billion, it is easy to understand why applying these technologies in medicine can significantly impact the way healthcare is provided worldwide. This article focused on the use of smartphone-compatible medical equipment (BP monitor – Wireless BP monitor; step counter – Pulse Ox; weight scale – Smart Body Scale Analyzer; and a single Lead-ECG device – Kardia) to regulate BP following AMI virtually, instead of going to a medical facility. Even though there was no statistically significant evidence that remote monitoring is better than in-person care (in this study), virtual visits proved valuable during the pandemic in 2020 since in-person visits were not advised. Not only can this method be used for AMI patients’ follow-ups, it is a more cost-effective method that can also be used for follow-ups on other pathologies, especially now that AI devices allow the measurement of different health variables beyond the clinical history for a more thorough examination.