If you want to understand how wearable technology can change the lives of cardiac patients, consider this real-life story.
One weekend, cardiologist Dr. Heather Ross got an alert, via the smartphone-based digital monitoring program Medly, that one of her patients, a 75-year-old female who lived in a rural Ontario town, had an increased heart rate. (The tool enables patients to measure and record key metrics including blood pressure, heart rate and symptoms.)
“Her heart rate was 110, which is above the individual parameters that we had set for her in Medly,” she explains. “I had the patient do their measurements again later in the day, and it was 120. I started to worry.”
The patient is living with heart failure, meaning that an elevated heart rate could be deadly, adding stress to the heart and increasing the risk of life-threatening arrhythmia.
Concerned, Dr. Ross called the patient directly. She found out the patient had forgotten a key medication while on vacation, a beta blocker that helps control heart rate. Dr. Ross was able to urgently call in the patient’s prescription to a pharmacy near where she was on vacation, enabling her to get back on her medication right away.
“Because Medly identified these trends in heart rate, we were able to say, ‘There’s something going on,’” she says. “Without that intervention, my fear was that she would have ended up in hospital.”
Technology like this – and the dramatic difference it can make to care for patients every day, wherever they are, who might not otherwise have access to this level of care – is “the stuff that makes me get out of bed in the morning,” as Dr. Ross puts it.
‘A moral imperative’
Dr. Ross is the head of cardiology at University Health Network’s (UHN’s) Peter Munk Cardiac Centre, a world-leading cardiovascular centre based in Toronto that delivers state-of-the-art care in one of the largest programs of its kind in North America. Dr. Ross is also site lead for the Ted Rogers Centre for Heart Research.
Advances in wearable technologies are enabling the Peter Munk Cardiac Centre to lead the world when it comes to monitoring patients outside of traditional clinic settings. It’s something that Dr. Ross says is key when you’re also trying to ensure that everyone, regardless of geography or socioeconomic strata, gets access to the best possible care.
“It’s a moral imperative” that’s only becoming more urgent, she says.
Globally, one in three deaths is caused by cardiovascular disease. Due in large part to an aging population, the incidence of this “incredibly common condition” will increase by an estimated 25 per cent by 2030.
Dr. Ross points out that, along with mortality, heart failure comes with a significant impact on your daily quality of life. It is the single most common reason for hospitalization.
As an example of what this disparity looks like in practice, Dr. Ross points to what it would be like to be a person with heart failure in Peawanuck, Ont., a fly-in Cree community on the shores of Hudson Bay.
“If you need to have your cardiac status assessed, or you need any form of advanced cardiac imaging, it is a three-to-five-hour flight with anywhere from one to six stops,” she says. “If you get yourself to Moosonee and you happen to get the Polar Bear Express, it’s about five more hours to Cochrane, and then to Toronto. It’s very hard to get care.”
Adapting tools to different communities
Dr. Ross has done that journey herself, driving the ice highway up to Moosonee and Moose Factory in 2022 as part of her work as co-lead of TRANSFORM HF (Heart Failure), a strategic initiative through the Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, in partnership with the University of Toronto, that is dedicated to digital transformation in heart failure care.
“Having been as fortunate as I have to travel, you clearly recognize that there is no such thing as equitable care at present,” she says. “Even in our country with socialized healthcare, we still know that there are incredible disparities in care – and those disparities can drive up the incidence of heart failure.” Those with the lowest income, she adds, have the highest incidence of heart failure.
One of the answers to bridging this gap – and keeping people in their communities to avoid unnecessary travel – is technology such as Medly, which was developed at the Peter Munk Cardiac Centre alongside eHealth Innovation at UHN and has been used by over 2,000 patients. The platform is a success story – to date, Medly has led to 50 per cent fewer heart failure-related hospitalizations at UHN’s Peter Munk Cardiac Centre and improved clinician to patient ratios.
“Patients see Medly as an extension of the clinic, and of their care,” says Dr. Ross.
The tool has also been adapted for use in different communities based on their individual contexts, including in Uganda. While internet coverage is unreliable in many parts of the country, it’s common to use cellphone-powered “mobile money” services to send and receive funds. Dr. Ross was part of a pilot study that adapted Medly to work on that interface.
“We are able to reduce hospitalizations, improve heart failure symptoms and improve adherence to medications,” she says, adding that this has now expanded to a larger study in six communities in Uganda that use three separate languages. “That type of technology could be scaled relatively inexpensively and have widespread benefit.”
Small devices, big impact
More broadly, Dr. Ross has a goal of “putting a hospital in a Pelican case” – those super-durable black boxes you’ll often see photographers using to transport delicate equipment.
Inside that case, the Peter Munk Cardiac Centre clinical team carries a range of wearable devices to distribute to people in rural or isolated communities. These devices include rings that detect sleep apnea at home and “patch Holter monitors” – small, waterproof heart monitors that record the heart’s rhythm to spot irregular heartbeats, also called arrhythmias. Once the recording is complete, these monitors can simply be dropped in the mail to the Peter Munk Cardiac Centre team for analysis.
Dr. Ross is particularly excited about the potential of using smart watches to monitor a patient’s cardiac and pulmonary activity.
“We’ve been able to show that we can predict when a change happens in a patient’s cardiopulmonary performance [with these watches],” she says. “In fact, we can see that change about seven days before they end up requiring hospitalization or care for heart failure.” This technology could provide, she hopes, early warning signals that could prevent someone from landing in hospital in the first place.
“There’s no doubt in my mind that these digital technologies are working, and that they’re improving the quality of life for patients,” says Dr. Ross.
And while there are plenty of exciting developments in the works – like a “lab on a chip,” where important blood tests can be analyzed in the field using a device the size of a credit card – Dr. Ross’s North Star remains constant.
“If we’re going to do this right, we have to make health equity an explicit goal,” she says.
This article originally appeared in The Globe and Mail, read it here.
No one ever changed the world on their own but when the bright minds at UHN work together with donors we can redefine the world of health care together.
