Use case of disease monitoring and self-management – example of heart failure

Role this area should play in the mHealth space

Although the role of remote monitoring of patients with long-term conditions is well regarded, robust evidence of the health outcomes benefit, impact on health services including cost benefit are difficult to find. This kind of evidence is critical for decision-makers, to justify investments in mobile health interventions for long-term conditions.

Current challenges and limitations
  • Determining which patients with heart failure are most suitable to receive mHealth solutions and are likely to experience benefits
  • Confirming that non-invasive remote monitoring can be effective for heart failure
  • Evidencing the cost benefit of mHealth for heart failure
  • Understanding if mHealth surveillance should be a short-term intervention, for example after hospitalisation, or should be a long-term strategy
What benefit could this bring to adopters of this innovation?
Evidence of health and financial benefits from mHealth solutions in long-term conditions can help Hub users when constructing business cases for future programmes. It may not be necessary for the evidence to be in the precise disease area being considered for a new programme, if a portfolio of similar convincing cases can give confidence and guide how a new business case could be framed.
How does it contribute to major EU policy priorities? (e.g. EHDS, COVID-19, DTHC etc.)
Non-communicable diseases still represent the greatest healthcare capacity and cost burden across Europe, set to increase with an ageing society. Methods of reducing healthcare service utilisation need to be promoted, and benefit from European level collaboration on sharing solutions and evidence.
If the use of mHealth, as illustrated here, lead to fewer hospitalisations and in-person clinic contacts, this will be of immediate value in response to COVID-19, when health systems are trying to reduce in person contacts and maximise hospital bed availability.


Importance of sustained remote monitoring

Approach or solution Impact of remote patient management in heart failure patients on reducing unplanned hospital admissions and mortality and, importantly, the loss of benefit when monitoring is discontinued.   Organisation or initiative Research publication: Mortality and morbidity 1 year after stopping a remote patient management intervention: extended follow-up results from the telemedical interventional management… ...

Cost effectiveness demonstration

Approach or solution Evidence of cost effectiveness of home telemonitoring for patients with heart failure.   Organisation or initiative Research publication: Jiang, X., Yao, J., & You, J. H. (2020). Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure Discharged From the Hospital in the United States: Cost-Effectiveness Analysis. JMIR mHealth and uHealth, 8(7),… ...

Impact of monitoring and feedback on compliance

Approach or solution A study demonstrating that the remote monitoring of one heart failure parameter, body weight, led to an overall improvement in compliance with heart failure management at home.   Organisation or initiative Research publication: Ding, H., Jayasena, R., Chen, S. H., Maiorana, A., Dowling, A., Layland, J., ... & Edwards, I. (2020). The… ...

Demonstrated health benefits from a sustained telemonitoring programme

Approach or solution This study showed that remote telemonitoring of patients with heart failure reduces hospitalisation, improves several clinical measurements of heart failure severity and patients’ physical and emotional well-being   Organisation or initiative Research publication: Ware, P., Ross, H. J., Cafazzo, J. A., Boodoo, C., Munnery, M., & Seto, E. (2020). Outcomes of a… ...

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What is on the horizon?
More studies in progress that will help strengthen the evidence base of health outcomes benefit and cost effectiveness benefit. They will also help to confirm which heart failure parameters are of greatest importance to measure on a regular basis.