Can the way patients use home monitoring tell us something about their heart health? – new iCARE4CVD study - iCARE4CVD

Measuring blood pressure, weight and activity at home can help people stay involved in their care after a serious heart problem. But not everyone keeps monitoring in the same way. New research from iCARE4CVD suggests that these differences in behaviour could provide useful information about who may benefit from additional support.

Why self-monitoring habits matter for heart health

After experiencing acute coronary syndrome – a sudden reduction in blood flow to the heart caused by a problem in the arteries supplying the heart – preventing another cardiovascular event becomes an important part of care.

Alongside medication and lifestyle changes, remote monitoring is increasingly used to support patients after a heart problem. Through remote monitoring, patients use devices at home to regularly measure factors such as their blood pressure, weight and physical activity. These measurements are sent to their healthcare team, allowing their health to be followed over time instead of relying only on measurements taken during hospital visits.

But having the technology is only part of the picture. For remote monitoring to provide useful information over time, patients need to keep using it – and not everyone does so in the same way.

Some people continue taking measurements regularly, while others gradually use their devices less or stop altogether. Could these patterns tell us something about how patients engage with their care – and help identify those who may benefit from extra support?

A new iCARE4CVD study set out to explore exactly that, led by Wouter van der Loo at Leiden University Medical Centre (LUMC), together with Tim van den Broek from the Netherlands Organisation for Applied Scientific Research (TNO) and colleagues.

The researchers followed how people who had experienced acute coronary syndrome used remote monitoring over the course of a year, investigating whether different patterns of self-monitoring were linked to cardiovascular risk factors and whether additional support could help patients stay engaged.

Three different patterns of self-monitoring

The researchers studied 1,181 patients taking part in a remote monitoring programme at Leiden University Medical Centre (The Netherlands) after acute coronary syndrome. Patients were asked to use home devices to monitor their blood pressure, weight and physical activity for 12 months.

The researchers followed patients’ use of the monitoring devices over the course of a full year, looking at how regularly they continued to take measurements and how this changed over time.

Three clear patterns emerged.

One group continued monitoring consistently throughout the year. In a second group, monitoring gradually declined, with patients taking fewer measurements as the year progressed. A third group reduced their monitoring more quickly, with little or no monitoring for much of the year. These same patterns had been identified in an earlier, smaller study, and finding them again in this larger group suggests they reflect recurring differences in how patients use remote monitoring.

For Wouter van der Loo, a PhD researcher and physician working in cardiology at LUMC, these findings highlight why remote monitoring needs to take individual differences into account.

“What these patterns show is that providing the technology is only one part of successful remote monitoring. A one-size-fits-all approach is unlikely to work for every patient: some integrate monitoring easily into their daily routine, while others may need more support over time.

That is important to recognise, because declining monitoring does not necessarily mean that a patient is unwilling to engage with their care. If we can recognise those differences early, we can make remote monitoring more personalised and better adapt support to the individual patient."

Can extra support help people stay engaged?

The researchers also looked at whether extra support could help patients continue monitoring. During the study period, a Medical Service Centre was added to the remote monitoring programme. A team of healthcare staff monitored the measurements patients sent in and could provide support when needed. If expected measurements were missing, for example, patients could receive a reminder. Technical support was also available if they were having problems with the devices. The team also checked the measurements for certain warning signs and could alert the patient’s doctor when needed.

After this extra support was introduced, the researchers saw a shift in how patients used remote monitoring. Before the Medical Service Centre was introduced, 42% of patients were in the group that monitored consistently. Afterwards, this increased to 60%. At the same time, fewer patients were in the groups whose monitoring declined over time.

These findings suggest that patients’ monitoring habits may not be fixed, and that reminders and practical support may help some patients continue using remote monitoring over time.

However, the researchers caution that the study cannot show that the extra support itself caused this change. The patients studied before and after its introduction took part in the programme at different times, so other changes – such as improvements to the programme, greater staff experience or changes in clinical practice – may also have played a role.

What does monitoring behaviour tell us about health?

The researchers also looked at whether the way people used remote monitoring was linked to differences in their cardiovascular risk factors – such as blood pressure, cholesterol and body weight, which can influence their risk of future heart problems.

Across all three groups, blood pressure and cholesterol levels improved over the year. However, people who kept monitoring regularly generally had healthier levels for several important risk factors. After 12 months, for example, they had a lower body mass index (BMI), total cholesterol, triglycerides (a type of fat in the blood) and diastolic blood pressure than people whose monitoring declined over time. They were also more likely to reach the recommended target for LDL cholesterol, often called ‘bad’ cholesterol, which is an important part of reducing cardiovascular risk.

But this does not mean that taking measurements more regularly made people healthier. Some differences between the groups were already present at the start of the study.

Instead, the researchers think that monitoring habits may tell us something about how people manage their health more generally. Someone who regularly checks their blood pressure, weight and activity may also be more likely to follow other parts of their care, such as staying active, eating healthily or managing their weight. The study did not measure these other behaviours, however, so this is something that still needs to be explored.

The researchers also looked at whether people in the three groups experienced further heart-related problems during the year. They found no clear difference between the groups in new acute coronary syndrome or heart failure-related events. More research, following patients for longer, is needed to understand whether monitoring habits could eventually help identify people who may be at greater risk of future heart problems.

From monitoring behaviour to more personalised support

The findings raise an interesting possibility: the way someone uses remote monitoring could itself provide useful information about the support they may need.

For example, instead of waiting until someone stops monitoring altogether, healthcare teams may one day be able to recognise earlier when a patient is starting to monitor less regularly and offer additional support. This could help make remote care more personalised – taking into account not only a patient’s health and medical measurements, but also how they use remote monitoring.

As a next step, the researchers want to explore whether monitoring patterns during the first four to six weeks could help identify which patients are likely to continue monitoring and which may need more support to keep going.

For Wouter van der Loo, the longer-term goal is to translate these insights into a more personalised approach to remote monitoring, where support can be adapted to the needs of individual patients.

"Ultimately, I would like this research to help make remote monitoring more personalised. Rather than using the same approach for every patient, monitoring behaviour may help us identify who is doing well with relatively little support and who may benefit from additional help.

The broader goal is to improve control of cardiovascular risk factors and, ultimately, reduce the risk of recurrent cardiovascular events."

More research is still needed before these patterns can be used to guide patient care. But the study highlights that remote monitoring may tell us more than a patient’s blood pressure, weight or activity levels. How people use these tools over time could also provide valuable information for their care.

Read the full research paper