Telehealth Could Keep Patients with Heart Conditions Out of Hospital

dr_andrew_maiorana_heartPresenter: Katherine Lodge
Guest: Dr Andrew Maiorana
Guest Bio: Dr. Andrew Maiorana is an associate professor at Curtin School of Physiotherapy and Exercise Science, and is a lead investigator in a project that Curtin University researchers have received funding to trial a nurse-supported telehealth management treatment to help patients with chronic heart failure.

Segment Overview

Andrew is here to talk to us about telehealth and how this could help patients with heart conditions to stay out of hospital.


Health Professional Radio – Patients with Heart Conditions Out of Hospital

Katherine Lodge: Thank you for listening to Health Professional Radio.  I’m Katherine, and for this segment, our guest is Dr. Andrew Maiorana.  He is an associate professor at Curtin School of Physiotherapy and Exercise Science, and is a lead investigator in a project that Curtin University researchers have received funding to trial a nurse-supported telehealth management treatment to help patients with chronic heart failure.  Andrew is here to talk to us about telehealth and how this could help patients with heart conditions to stay out of hospital.  Welcome to our show.

Dr. Andrew Maiorana: Thank you.

Katherine: Hi, Andrew.  So just to start off with, can you tell us what telehealth is?

Dr. Maiorana: Telehealth is using communications technology and the Internet to support people in managing their health conditions.  It involves a number of different components.  Historically, telehealth has utilised telephone calls, but more recently, there are many more options that can be utilised in the telehealth setting.  So we can use the Internet, online systems where patients can upload clinical information about themselves.  And also, using text messages to send reminders to people, sending them email reminders.

Really, using all of those technologies to increase the communication between the patient and their healthcare providers.  And also, to convey information to patients to help them manage their own health.

Katherine: Right.  Thanks for explaining that to us.  And I’m glad you mentioned some of the different options, because I do think a lot of people do think about the Internet as a great resource, and it is.  But I imagine some of the patients that don’t rely on the Internet, and maybe some of the … I don’t want to generalise, but maybe some of the older generation, they do prefer the phone calls and things like that.  Just clarifying that.

Dr. Maiorana: We’re finding that even older patients are becoming increasingly Internet-aware, and we think it’s really a good time now to start looking at the potential for the Internet to help people in managing their health.  A lot of people are already accessing the Internet for a lot of health information, but there are lots of other mechanisms as well that the Internet can be useful for.

Katherine: Right, exactly.  Yeah, like I said, I didn’t want to generalise to say some of the older … but yeah.  Definitely, being tech-savvy is not linked to age whatsoever.  And like you said, some of these technologies, the barrier to entry is quite low, so that’s good to hear.  Would you be able to explain to us about this particular project?  I understand it’s a collaboration between quite a few organisations.  Can you explain that to us?

Dr. Maiorana: Sure.  It’s a project that will be conducted out of Curtin University, but it involves collaborations with the Western Australian Health Department as well as some national and international collaborators.  We’re collaborating with the George Institute for International Health at the University of Sydney and also have a collaborator from the USA, from Johns Hopkins University, who’s an Australian professor of nursing who’s currently working in the US.  So it really is a program that is utilising the skill sets of people from far and wide.

Katherine: Right, exactly.  And the funding that was received, it’s for a two-year research project, is it?  Can you explain to us about that?

Dr. Maiorana: Yeah.  It’s been allocated through the Western Australian Department of Health, through their Targeted Research Fund.  The Targeted Research Fund was really looking to fund projects that used innovative approaches to help manage complex conditions in the primary care setting.  So this is really patients who are being managed, by and large, in the community by their GP.  And this project is specifically about helping people with a condition known as heart failure manage their condition.

Heart failure is quite common in people as they get older.  It probably has a prevalence of about 1 to 2% in the general community.  But by the time that people get to 65, about 10% of people have some degree of heart failure, and then that increases as people get older.  Now, heart failure describes a c condition where the heart isn’t pumping as well as it should.  It’s quite a threatening term, and people often get quite worried about what heart failure means.  It doesn’t necessarily mean that the heart’s completely failed.

There are degrees of heart failure.  But essentially, it’s a situation where the heart isn’t pumping as well as it should, and the cardiac output, the amount of blood leaving the heart, is lower than we would expect with a normal, healthy heart.  That has an effect on a person’s health, obviously, and it can lead to symptoms.  And ultimately, it can lead to quite frequent admissions to hospital.

What we know about heart failure and the symptoms associated with it is that a lot of the admissions to hospital occur because people aren’t managing their heart failure as well as they should.  So a lot of the hospital admissions are preventable—perhaps as many as 50%.  So the idea of this project is to use telehealth to provide improved support for the patient at home, but also to have some red flags.  So the patients put their information into an online system, or they can ring it in to one of our nurses if they’re not familiar with using the Internet.  Our nurse can actually do that.

And then the system comes up with red flags when patients have indications that might suggest that their condition is getting worse.  At that point, we link them in to their GPs, make sure that they get an early appointment with their GP, and then hopefully, the condition can be stabilised at that point, before it progresses and people need to go to hospital.

Katherine: Right, yeah, so the whole prevention better than cure type of thinking as well.

Dr. Maiorana: Yes, yes.  We know that lots of people, when they end up in hospital with a readmission due to their heart failure, their symptoms have been getting worse for a period of time.  And if we can nip that in the bud early—and it may be as simple as just making some slight changes to their medication.  It may be that they’re not managing their lifestyle as well as they should.  One of the things with heart failure is that if people drink too much fluid, the heart doesn’t cope with that, and that can cause fluids to be retained in the body.

It can cause fluid to build up in the lungs, and that can cause shortness of breaths and problems that ultimately lead to people turning up at an emergency department and getting admitted to hospital.

Katherine: Right, right.  Well, it sounds like it’s a really great system, and currently, it will be in Western Australia for now, to start with.  Is that right?

Dr. Maiorana: That’s right.  This project is just occurring with patients in Western Australia.  But I’m aware of some other projects that are happening elsewhere in Australia that are also using telehealth to help manage people’s health, and cardiac and vascular health, specifically.  So it’s really quite a growing area of healthcare.  And yeah, it’s certainly at its infancy at the moment, but we’re really [indecipherable 09:09] to explain what the potential is of using communication technology, using the Internet to help people manage their health.

Katherine: Yeah, exactly.  And thank you so much for your time today, and best wishes for the rest of the research.

Dr. Maiorana: It’s a pleasure, Katherine.

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