Elderly man seated on sofa making a video call to his doctor.

At-home monitoring devices, tools play leading role in patient care during pandemic

When you think of the San Francisco Bay Area, those young, tech-savvy college graduates who work for some of the world’s largest software companies there may first come to mind. But this bustling metropolitan area is also home to nearly 1.5 million people age 65 and older.

So when the city went into its first lockdown in March to try to halt the spread of the novel coronavirus, many older adults who receive cardiology care at the University of California San Francisco Medical Center started worrying about their doctors’ appointments. And some of their doctors did, too. How could they diagnose their patients, they wondered, without laying hands on them?

But they didn’t have to worry for long. To the doctors’ amazement, the patients soon became tech wizards, communicating through telemedicine services and recording important patient information with wearable devices.

That unexpected turn of events signaled a trend now happening across the country as a result of the coronavirus crisis: accelerated use of virtual spaces for routine medical appointments. As more and more patients become receptive and adaptive to such at-home monitoring devices during the pandemic, Liviu Klein. M.D., a cardiologist at UCSF, speculates that these tools are likely here to stay.

Klein is one of many investigators supported by the NHLBI who are designing and implementing new technologies so that adults with preexisting conditions can monitor their heart and lung function from the comfort of their own homes.

Wearable patch hardware shown opened to allow the internal electronics to be visible.
Wearable patch hardware developed by the Inan Research Lab at Georgia Tech and the Etemadi Lab at Northwestern for monitoring patients with heart failure. The patch is shown opened to allow the internal electronics to be visible. Credit: Omer Inan, Ph.D., Georgia Tech; Mozziyar Etemadi, M.D., Ph.D., Northwestern University.

“As doctors, we want our patients to live longer and feel better. And the only true way to assess that is when our patients are in their own environments--and the pandemic has helped us glean that,” said Klein, who is conducting clinical studies of a wearable device that could help people with heart failure, with the help of their doctors, track how their hearts are functioning.

About 6.5 million Americans are living with heart failure, which means their hearts cannot pump enough blood to meet the body’s needs. Heart failure is a serious condition that often requires patients to undergo exercise stress testing. Severe heart failure can require long stints in the hospital due worsening symptoms, often times complicated by the need for invasive medical procedures or surgeries, which can be expensive. Patients with heart failure also require routine check-ups with their doctors to monitor their heart function. Despite safety precautions at hospitals, patient angst over coming to the hospital has been amplified by their fear of contracting COVID-19 during their visit. 

Klein’s collaborators, Omer Inan, Ph.D., associate professor of electrical and computer engineering at Georgia Tech, and Mozziyar Etemadi, M.D., Ph.D., research assistant professor of bioengineering and anesthesiology at Northwestern University in Illinois, designed a wearable device that is addressing some patients’ worries and risks. The device continuously tracks how a patient’s heart responds to daily activities, like walking or climbing stairs. It allows people with heart failure to perform mini stress tests at home by measuring small movements of the chest wall every time the heart beats. The movements resemble the seismic vibrations of the earth after an earthquake—but markedly smaller.

“Seeing patients in the hospital or the office means they are subjected to controlled conditions, and we make decisions that affect their lives outside of these conditions,” Klein said. “Having devices that people with heart failure can wear at home will improve their quality of life, and the data we collect from them will be more realistic.”

Results from clinical studies—especially the ones that show how a patient’s heart function correlates with their overall health—have been promising. And in a few more years, they could make possible more frequent assessments, allowing doctors to recommend dietary changes, exercise prescriptions, or changes to patient’s medication all without stepping foot into the doctor’s office.

Some 2,400 miles away in Ohio, Nishant Gupta, M.D., associate professor of medicine and director of the University of Cincinnati Medical Center’s Interstitial Lung Diseases Center, is seeing the devastation of the pandemic firsthand while working in the intensive care unit. But he has developed peace of mind knowing that he can safely monitor the lung function of his patients with a rare lung disease called lymphangioleiomyomatosis (LAM).

“If we didn’t have home spirometry built into our clinical trials before COVID-19 hit, I don’t know if we would have been able to safely monitor these patients’ lung function,” Gupta said.

Gupta leads two sub-studies that are assessing if it’s feasible and reliable for LAM patients to perform the lung function test at home in addition to investigating the fidelity of long-term monitoring by home spirometry. One study is tied to the Resveratrol and Sirolimus in Lymphangioleiomyomatosis Trial (RESULT) and the other is part of the Multicenter Interventional Lymphangioleiomyomatosis Early Disease Trial (MILED).

Doctors view home spirometry as the future for monitoring lung disease progression in LAM and other chronic lung disease patients. These home tests are especially relevant today. That’s because since the pandemic, the use of some lung function tests have been restricted because of the possibility that they could spew infectious particles into the air. This, he said, has led institutions to temporarily pause or limit lung function tests to urgent cases only.

“If a person is enrolled in a blinded placebo-controlled trial, they don’t know whether they’re getting a drug or a placebo and may be worried about a decline in their underlying lung function. Yet they may not be able to undergo regular monitoring with an office-based test due to COVID-19 related restrictions,” Gupta said. “But if they have a home-based test, they can use it as often as they’d like from the comfort of their home and track their progression with confidence. This has prevented a lot of sleepless nights both for investigators as well as the patients during the pandemic.”

The current standard of monitoring treatment response in patients with LAM and a number of other chronic lung diseases is through repeated measurements of lung function performed with office-based spirometry, which is the most robust measurement of lung function over time. Typically performed in the office every three to six months, Gupta said that spirometry done this way gives doctors confidence about a treatment response, even though tracking the trajectory of the disease could take well over a year. But with use of home spirometry, which allows patients to check their lung function on a more frequent—sometimes as often as daily—basis, doctors could assess the course of the disease in a much shorter period and make the necessary treatment decisions.

The patients enrolled in Gupta’s studies use a home spirometry device with a built-in avatar that coaches the patients through the maneuver and provides real time feedback based on test quality. Patients are instructed to use the device at least once a week and the results are seamlessly transmitted to the study team through a secure online portal.

Back east at the Brigham and Women’s Hospital in Boston, some patients at risk for heart disease have been using a different kind of monitoring device—and they’ve been getting results without leaving their homes. Peter Libby, M.D., a preventative cardiologist at the hospital, said last spring that almost all his outpatient appointments were virtual. Two of his patients developed irregular heartbeats during this stressful period, and after a virtual visit, he recommended specific devices that could be used to record their electrocardiograms and send the result to him via email. Within days, Libby said, he was able to tell the patients the diagnosis of the rhythm and formulate a management plan for the palpitations.

“We will never replace the face-to-face physician-patient interaction because there are many things in cardiology that require a physical examination,” Libby said. “But remote monitoring has proven to be a real possibility for the long term. And in the end, with proper safeguards, it will make doctors more efficient and empower and engage patients as partners in their care.”