The growing burden of cardiovascular diseases in the Indian population and its current strain on India’s healthcare resources warrant innovative modalities of healthcare delivery. Given the shortage of skilled personnel like doctors, nurses, and healthcare workers in India, it will be challenging to meet the ever-increasing healthcare demands of patients with noncommunicable diseases in the future. Moreover, the lack of engagement between patients and doctors reported in studies and the increasing prevalence of cardiovascular diseases in remote rural populations pose unique challenges to the delivery of cardiovascular disease services to patients and high-risk individuals.
The concept of “telecardiology” can help navigate the complex landscape of cardiovascular disease management in India. It involves the remote, real-time diagnosis and treatment of cardiovascular illnesses like congestive heart failures, cardiac arrests, and arrhythmia over secure-video feeds or phone calls. Telecardiology also entails the remote monitoring of clinical parameters like blood pressure, blood glucose levels, and ECG readings. Recent technological breakthroughs enable the seamless integration of monitoring patients’ symptoms remotely into medical practice. For example, AliveCor’s KardiaMobile device is a smartphone-connected, portable ECG device that can be used as a telecardiology tool. Patients can record their ECGs by placing their fingers on pocket-friendly electrodes and view their real-time ECGs on their smartphone screens. These ECG recordings can then be securely emailed to their doctors for further evaluation. Such devices can greatly enhance the patient experience and simplify the way healthcare is delivered.
A major part of patients’ cardiovascular healthcare journeys happens outside the walls of healthcare facilities, so doctors would benefit from novel ways to regularly monitor their patients’ progresses to ensure they remain an active part of their patients’ healthcare journeys. Leveraging India’s unprecedented expansion in Internet services and the latest tech advancements for telecardiology provision can have positive impacts on both patients and healthcare providers. Some of the benefits of telecardiology are listed below:
Reduction in hospitalization rates – Systematic reviews have reported decreased hospitalizations and readmissions of patients after telemedicine adoption. This also has implications for healthcare providers. The costs associated with readmittance and hospitalization of patients will also reduce due to the remote delivery of timely post-operative care and thus, prevention of adverse outcomes.
Improved patient outcomes – Several studies have demonstrated the positive impacts of telecardiology tools on cardiovascular disease patient outcomes. In one study, a telemonitoring system for heart failure patients enabled doctors to provide real-time instructions on how to modify lifestyle behaviours. Patients also felt less anxious and more reassured because of the enhanced reachability to their healthcare team. This telemonitoring system involved sending daily weight and blood pressure readings electronically to the doctor, weekly single-lead ECGs, and mobile phone conversations about patients’ daily symptoms. Another study demonstrated that a telemedicine service consisting of electronic transmission of patients’ blood pressure measurements to doctors and nurse-managed telephone support was associated with a greater decrease in mean systolic and diastolic blood pressure values than patients who only received usual care.
Economic benefits – Telecardiology tools are economically beneficial for both patients and healthcare providers. Patients will incur lower out-of-pocket expenditures as a result of reduced number of visits to healthcare facilities for routine checkups or emergencies. Remote patient monitoring and healthcare delivery for cardiovascular disease patients can help expand the capabilities of healthcare providers without the need to increase the size of the healthcare workforce. Thus, healthcare can be delivered at lower costs without compromising on the quality.
Cardiovascular disease patients require regular monitoring to prevent adverse outcomes, and telecardiology is an agile way forward to ensure care of superior quality is delivered to these patients from the convenience of their homes. As Dr Ami Bhatt, MD, FACC, who is the director of the adult congenital heart disease program at Massachusetts General Hospital in Boston, rightly put it: “As we’re moving towards value-based health care, we need to bring outpatient cardiology directly to our patients in the communities where they live…and that means incorporating telehealth and digital health into our practices.”