NEJM | Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine
In Utero Exposure to Maternal COVID-19 Vaccination and Offspring Neurodevelopment at 12 and 18 Months
Erica S. Spatz, , Geoffrey S. Ginsburg, John S. Rumsfeld, and Mintu P. Turakhia
N Engl J Med 2024; 390:346-356
DOI: 10.1056/NEJMra2301903.
This review article presents a three-part true-life clinical vignette that illustrates how digital health technology can aid providers caring for patients with cardiovascular disease. Specific information that would identify real patients has been removed or altered. Each vignette is followed by a discussion of how these methods were used in the care of the patient.
Vignette, Part 1: Remote Monitoring of Cardiovascular Disease
A 62-year-old woman with long-standing hypertension presents to the emergency department with decompensated heart failure and newly identified atrial fibrillation with rapid ventricular response. She is admitted for further evaluation and treatment and is found to have a left ventricular ejection fraction of 30%, which is thought to be tachycardia mediated from uncontrolled atrial fibrillation. After cardioversion and initiation of anticoagulation, antiarrhythmic drug therapy, and guideline-directed medical therapy for heart failure, she was enrolled in a remote patient monitoring program. Five days after discharge, she received a toolkit by mail that consisted of a blood-pressure cuff, a scale, a pulse oximeter, and a cellular hub that would transmit data to the remote care team.
Vignette, Part 2: Continuous Monitoring with Wearable Technologies
In the second week of monitoring after discharge, the patient’s weight increased by 2.3 kg (5 lb). The remote-monitoring nurse called the patient, who reported increased dyspnea on exertion and occasional palpitations. The patient was able to assess herself for edema in the lower legs and noticed pitting. Blood pressure was elevated, averaging 152/84 mm Hg; resting pulse oximetry was unchanged. She reported no adverse effects with the use of the angiotensin receptor–neprilysin inhibitor, beta-blocker, sodium–glucose cotransporter 2 inhibitor, and direct oral anticoagulant, which had been prescribed at discharge. To achieve better blood-pressure and volume control, the nurse increased the dose of the beta-blocker, added a mineralocorticoid receptor antagonist, and doubled the dose of the diuretic for 3 days. A follow-up basic metabolic panel and measurement of the pro–B-type natriuretic peptide level were ordered. An ambulatory electrocardiography (ECG) monitor to evaluate the cause of palpitations and to assess the atrial fibrillation burden was also prescribed and shipped to the patient.
Vignette, Part 3: Graduating from Remote Patient Monitoring
The patient continued working with the remote patient monitoring team to adjust the guideline-directed medical therapy as needed. Her symptoms improved, and her weight and blood pressure were stable. Ambulatory ECG monitoring showed sinus rhythm with rare premature ventricular contractions but no atrial fibrillation. After 90 days of monitoring, she had not required readmission, had verbalized understanding of her medications, and planned to continue to monitor her weight and blood pressure daily. She met criteria for readiness to graduate from the program. Remote patient monitoring was discontinued and the patient was referred to her clinical team for ongoing care.
