Why UC Davis is turning to mHealth tech for post-angioplasty care

Post-discharge is a critical period for the overall success of any given procedure. If patients do not follow discharge instructions or clinical changes occur without the care team’s knowledge, the patient could suffer adverse outcomes and require additional inpatient care. Healthcare provider organizations are examining novel approaches to better manage the postoperative period, including the use of mHealth technology.

Last month, UC Davis Health became one such health system, launching an at-home digital care program for patients who have undergone a percutaneous coronary intervention (PCI) procedure.

Heart disease is the No. 1 killer of Americans, outstripping the second leading cause, cancer, by approximately 90,000 deaths, according to data from the Centers for Disease Control and Prevention (CDC). The most common type of heart disease is coronary artery disease (CAD), which reduces the blood flow to the heart, causing arrhythmias, heart failure, or a heart attack.

A PCI, also known as an angioplasty, is a minimally invasive procedure that aims to open the coronary artery, the blood vessel brings blood and oxygen to the heart muscle, with balloons and stents to restore blood flow. Research shows it is generally safe to discharge patients to their homes the same day after a PCI, but they face numerous risks post-procedure.

“They are at risk of repeat heart attack if they do not take their medications or do not control their risk factors, which are diet, exercise, or blood pressure control, to help,” explained Surabhi Atreja, MD, associate professor of cardiology at UC Davis Health, in an interview with mHealthIntelligence. “And then in this particular period, just after angioplasty, there are a lot of post-procedure instructions which patients have to follow, like how much weight they can lift, so as to avoid bleeding.”

In the past, UC Davis Health, like most organizations, provided patients with paper instructions. However, the health system established a digital care program to provide more comprehensive support for patients in the critical post-discharge period following a PCI.

USING MHEALTH TECH TO MANAGE PATIENT CARE POST-PCI

UC Davis’ post-PCI digital care program involves using an asynchronous text messaging platform and remote patient monitoring (RPM) technology to monitor patient vitals.

According to Atreja, who is helping oversee the program, patients receive text messages through the UC-NOW platform with information about their post-procedure care, including dietary information and reminders to take their daily medications.

The in-house platform also enables two-way texting, which allows UC Davis’ care team to reach out with specific questions that patients can answer. Depending on the response, clinicians may contact the patient to address post-surgery challenges.

“This way, we feel very confident that after getting the procedure, their questions are well answered, and they have all the instructions to follow up in this perioperative period,” she said.

The RPM technology platform supplied by digital health company Clinii includes a weight scale, blood pressure kit, and 4G hub that transmits data to the clinical team. This allows the UC Davis care team to remotely track patient vital signs and tackle clinical issues as they appear.

“We realized that without having a blood pressure reading and weight, it is very difficult to truly understand what is going on with the patient at home short of examining them,” Atreja said. “Blood pressure or vitals give us very important information about how the patient is doing.”

The platform comes with its own internet connection to circumvent internet connectivity challenges. Additionally, the care team enrolls the patient in the platform while in the hospital and takes the first few readings there. When patients get home, they receive reminders to check their vitals and the data is automatically transmitted to the UC Davis care team.

The care team adjusts the patients' medication dosage or other aspects of their post-PCI plan based on the data they receive.

The platform also has audio and video call capabilities, through which the care team can contact the patient directly. Atreja believes this access to their care team greatly improves the patient experience.

“It gives them an extra layer of comfort that they can reach their doctors, and somebody is watching over them because we frequently give them either a call or if they are very compliant, we applaud them for doing that,” she said.

Comprehensive support in the first 30 days after a PCI is critical. Atreja noted that this program aims to provide that support through patient education, communication, and objective vital signs data to boost clinical outcomes.

PROGRAM DEPLOYMENT STRATEGIES

The at-home digital care program for patients post-PCI is a multi-department effort, with the UC Davis Health IT team, cardiology department, and medical students contributing to program development and deployment.

Atreja stated that the departments tested various aspects of the program before the launch, including the platforms, devices, and communication approaches. For instance, the text messages sent through the UC-NOW platform went through multiple iterations. Atreja and a medical student assessed the texts to ensure they weren’t too wordy or complicated to understand. They also adjusted the number of texts patients received to ensure the patient did not develop alert fatigue.

Another critical consideration was ensuring consistent RPM device use at home.

“We realized that maybe there is an inertia when the patient is discharged home; they are overwhelmed, they don't even take the device out of the box and plug it in for a few days,” Atreja said. “And after learning from five, six patients, we realized that okay, the best would be to open the device, actually open the package right in the recovery area, and [take] first readings while they are in the hospital. And that helped a lot.”

The program, which is supported by grants from the American College of Cardiology and the Rosenfeld Foundation, also underwent a review by the health system’s institutional review board. The board assesses the security and safety of the technology used in new programs and ensures that they do not curb health equity.

The UC Davis team now plans to compare the outcomes of the 200 patients enrolled in the digital care program with a control group that is not enrolled to evaluate the efficacy of the approach, Atreja noted. The study will compare various outcome metrics, including blood pressure control, heart rate control, medication compliance, and the 30-day readmission rate. They will also compare the rates of recurrent cardiac events, such as major adverse cardiac events (MACE), over a one-year period.

Eventually, UC Davis hopes to expand this type of digitally enabled at-home care to other post-procedure care pathways. But for now, it is focused on making a case for the standard use of digital care tools in post-discharge cardiac care.

“I feel that this pathway, what we are trying to test, should be routine care for this high-risk population,” Atreja said. “We hope that this model one day can become a national model in every Cath lab and that every procedure doesn't just end with the procedure, but it becomes a heart health activation center or journey for these patients.”