Fellow's Corner: Mobile Health: A Tool to Improve Quality of Life for Cardiac Patients

Over the past 50 years, medical and technological advances in pediatric cardiology and cardiothoracic surgery have resulted in a large decline in mortality among children with congenital and acquired heart disease. As short- and long-term survival rates have increased, research has focused on innovative ways to decrease morbidity and improve quality of life.

Within the Division of Cardiology at Children’s Hospital of Philadelphia (CHOP), a wide array of mobile health technologies, including telemedicine, wearable devices, and smartphone applications, are being implemented and researched with these goals in mind. These technologies provide families an opportunity to engage with healthcare providers and aim to decrease geographic and sociodemographic disparities in access to care. As a pediatric cardiology fellow interested in mobile health, I wanted to highlight a few of the ways cardiologists are using these technologies to improve patient and family quality of life.

The COVID-19 pandemic has reaffirmed the importance of telemedicine. It has given healthcare providers a tool to continue patient care while minimizing the potential for COVID-19 exposure. Since March 2020, our Cardiac Center has completed nearly 4 000 telemedicine visits spanning all cardiac subspecialties. The Infant Single Ventricle Monitoring Program (ISVMP), a program that monitors medically fragile infants undergoing staged surgical palliation, was the first to institute a telemedicine program in 2019 and rapidly expanded during the pandemic. To date, it has completed more than 300 visits. These visits have been feasible and effective in clinical decision-making, prevented unnecessary emergency room visits, and identified significant clinical concerns resulting in expedited patient follow-up and high caregiver satisfaction. The program continues to work toward enhancing the telemedicine experience by investigating the use of digital stethoscopes to allow for remote patient auscultation.

As wearable devices have become increasingly accessible and technologically advanced, we have begun to discover their diverse applications in healthcare. Recognizing the time limitations, lifestyle disruptions, and lead irritation associated with standard ambulatory heart rate monitors, researchers in the Electrophysiology and Heart Rhythm Program have been evaluating the ability of the Apple Watch to monitor heart rates and detect arrhythmias in children and young adults. In the Lipid Heart Clinic, researchers are using Fitbit devices to investigate the impact of motivational text messaging and goal setting on physical activity in teenagers with obesity and elevated cholesterol.

In an age where smartphone use has become nearly ubiquitous, mobile health applications have the ability to close the communication gap between patients and providers. The Heart Failure and Transplant Program has 2 research studies using the MyHeart CHOP app to provide safe and effective exercise prescriptions, monitor adherence, and enhance communication with patients who have Friedrich’s ataxia and hypertrophic cardiomyopathy. ISVMP will be launching its own app in the coming months. This app will give providers access to real-time home monitoring data, including oxygen saturations and weight measurements, while empowering families to manage these complex patients at home.

Contributed by: Rachel Shustak, MD