Center for Digital Health

Improving Patient Outcomes in Cardiothoracic Surgery: A Telemedical Approach

Digital health technologies are changing postoperative care for patients who underwent cardiothoracic surgery.

Doctor in a white coat holding out a mobile tablet with an image of an anatomical heart on it.The field of medicine has changed significantly over time with rapid technological advancements being integrated into our healthcare systems. Telemedicine, which has been recorded used as early as the 1950s, has also evolved over the past few decades [1]. Although telemedicine has existed in our healthcare system and gradually been implemented into modern models of care delivery, it has recently gained its most attention and appreciation due to the immense surge in usage of these technologies during the COVID-19 pandemic. In the height of the pandemic in the US in April 2020, usage of telehealth services for office visits and outpatient care was roughly 80 times greater than in February 2020 [2]. 

Utilization of telehealth technologies has also been integral in the field of cardiothoracic surgery, particularly for preoperative and postoperative remote patient monitoring to improve outcomes for surgical patients. Cardiovascular disease remains the leading cause of mortality in the US, with over 900,000 cardiac surgeries such as coronary artery bypass grafting, heart transplants, and valve replacements being performed in the US annually [3]. Close initial monitoring of patients’ conditions is needed to inform clinical decision making, as well as extended postoperative monitoring to evaluate vitals, symptoms, wound healing, etc. Telemedicine has great potential to facilitate quality access to this type of care to optimize outcomes for surgical patients, while also reducing hospitalization times and costs. 

Various telemedical approaches for remote monitoring of patients who underwent cardiothoracic surgery are currently being developed, tested, and utilized. Interventions range from telephone surveys of symptoms to vitals self monitoring kits to interventions with mobile/web-based applications, teleconferencing and more. For example, a recent pilot study evaluated usage of a Remote Mobile Outpatient Monitoring in Heart Transplant (ReBOOT) mobile health app for patients who underwent heart transplant surgeries [4]. Patients were also given a smartwatch, scale, blood pressure cuff, thermometer, and sleep tracker that were paired with the mobile app to track vitals postoperatively and provide automated reports to healthcare providers. Another recent pilot study analyzed usage of a bluetooth-tablet based technology for evaluating clinical parameters of pulmonary function for lung transplant recipients recently discharged from the hospital [5]. Novel technologies are also being developed and tested in small-scale settings. For instance, a recent study has looked into usage of a mobile cardiac arrhythmia diagnostics monitoring system for remote ambulatory cardiac monitoring (rACM) before and after patients receive transcather aortic valve replacement procedures [6].  

Overall, these studies have had significant success in improving postoperative outcomes for cardiothoracic surgery patients. Telemedicine has made possible extended monitoring of patients beyond their time in the hospital, ultimately preventing readmissions, allowing for early identification of adverse events, reducing inpatient days and overall costs, and more. Reviews for uses of telemedicine in cardiovascular surgery during the COVID-19 pandemic also highlight the huge role that telemedical approaches for remote monitoring and teleconferencing played in facilitating triage and pre/postoperative care of these patients during the pandemic [7]. 

While these interventions have many positive elements, there is still significant room for improvement related to ease of communications between provider and patient, frustration from excessive notifications, added workload for healthcare providers, and general improvements to the interface of technologies to include more features. These technologies also have great potential in improving access to quality care for patients with lack of access to physicians and comprehensive healthcare, yet costs of these technologies/insurance reimbursement structures may make it difficult for patients from varying socioeconomic backgrounds to access.

Given the high prevalence of cardiovascular disease in the US, widespread efforts and initiatives are needed to enhance care delivery to patients, even from the comfort of their own home. As rapid advancements continue to be made towards refining telemedical technologies, these interventions will become more integrated into our dynamic models of healthcare delivery with the ultimate goal of optimizing quality healthcare for patients. 



 

References 

  1. Services, Board on Health Care. “The Evolution of Telehealth: Where Have We Been and Where Are We Going?” The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary., U.S. National Library of Medicine, 20 Nov. 2012, https://www.ncbi.nlm.nih.gov/books/NBK207141/
  2. Bestsennyy, Oleg, et al. “Telehealth: A Quarter-Trillion-Dollar Post-Covid-19 Reality?” McKinsey & Company, McKinsey & Company, 22 July 2021, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
  3. iData Research. “How Many Cardiac Surgeries Are Performed Each Year? - New Study by Idata Research.” IData Research, 1 Mar. 2021, https://idataresearch.com/over-900000-cardiac-surgeries-performed-every-year-in-the-united-states/
  4. Moayedi, Yasbanoo et al. “Remote Mobile Outpatient Monitoring in Heart Transplant (ReBOOT): A Pilot Study.” The Canadian journal of cardiology vol. 36,12 (2020): 1978.e9-1978.e10. doi:10.1016/j.cjca.2020.07.005
  5. Schenkel, Felicia A., et al. “Use of a Bluetooth Tablet‐Based Technology to Improve Outcomes in Lung Transplantation: A Pilot Study.” Wiley Online Library, John Wiley & Sons, Ltd, 13 July 2020, https://onlinelibrary.wiley.com/doi/10.1111/ajt.16154
  6. Winter, Jose L et al. “Remote Ambulatory Cardiac Monitoring Before and After Transcatheter Aortic Valve Replacement.” CJC open vol. 2,5 416-419. 25 Apr. 2020, doi:10.1016/j.cjco.2020.04.006
  7. Ajibade, Ayomikun et al. “Telemedicine in cardiovascular surgery during COVID-19 pandemic: A systematic review and our experience.” Journal of cardiac surgery vol. 35,10 (2020): 2773-2784. doi:10.1111/jocs.14933