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Case Presentation
A 40-year-old man presented with past medical history of New York Heart Association (NYHA) class III heart failure with ejection fraction of 35%, atrial fibrillation, status post cardioversion 2 times, and nonischemic cardiomyopathy. Other comorbid conditions include diabetes mellitus, hyperlipidemia, and hypertension. The patient presented to the hospital with worsening dyspnea, decreased exercise tolerance, and pedal edema for 1 week. During the previous year, he had 5 hospitalizations for acute decompensated heart failure and continued to struggle with volume management on an outpatient basis.
The patient's home medications include amiodarone 200 mg once a day, carvedilol 25 mg 2 times a day, sacubitril/valsartan (Entresto) once a day, aspirin, atorvastatin 40 mg at bedtime, apixaban (Eliquis) 5 mg 2 times a day, and torsemide 40 mg 2 times a day.
On examination, blood pressure is 118/90 mmHg, heart rate is 78 bpm with an irregularly irregular rhythm with holosystolic murmur at apex, and there is positive jugular venous distention, crackles from base-midlung bilaterally, and bilateral pitting pedal edema.
Significant laboratory values included elevated pro-B-type natriuretic peptide to 30,000 ng/dL (baseline 20,000-25,000) and creatinine of 1.8 mg/dL (baseline 1.4). Ultrasound of bilateral lower extremities was negative for deep vein thrombosis but positive for subcutaneous edema.
This patient was referred to heart failure management with CardioMEMS implantation.
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KEY POINTS
Several studies have shown that patients with NYHA class III heart failure, managed with an implantable hemodynamic monitoring system, had significant reduction in hospitalization regardless of their ejection fraction. This additional information about pulmonary artery pressure in addition to clinical findings facilitates efficient management.
Remote heart rate monitoring devices have been used for arrhythmia detection, especially in diagnosis of atrial fibrillation in stoke patients.
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The global reach of modern technology, coupled with significant advances in computational power, marks a milestone of newfound potential in the development of digital health systems.
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Although telemedicine is not a new concept, the widespread emergence of remote health monitoring initiatives across the United States has sparked fresh enthusiasm for the potential of next-generation digital tools to bridge pervasive gaps in the accessibility, affordability, and quality of healthcare.
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For individuals managing chronic medical conditions, remote monitoring initiatives could create enabling environments of supported self-management and better personalized treatment plans. Remote sensor technologies allow healthcare to continue beyond the traditional clinical setting.
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Such devices can be handheld, implanted, worn, or placed in the surrounding environment to capture health data and then electronically transmit that information back to healthcare providers for assessment. Several remote monitoring devices are described in Table 10-1. For the sake of convenience, only pertinent ones will be discussed in detail.
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