Integrating avatar technology into a telemedicine application in heart failure patients : A pilot study.

BACKGROUND: Heart failure is a severe condition and telemedicine can improve the care of heart failure. Many patients are unable to use telemedicine applications due to visual impairment and limited health-related literacy. Avatar technology might help to overcome these limitations. METHODS: A telemedicine application was combined with a nurse avatar and offered to heart failure outpatients for 3 months. System usability and patient satisfaction were evaluated monthly by the system usability score (maximum score=100) and the patient satisfaction scale (maximum score=50). RESULTS: In total, 37 heart failure patients were enrolled. The mean system usability score after 1 month was 73 (standard deviation=24) and 72 (standard deviation=10) after 3 months of follow-up, which was not significantly different (p = 0.40). The mean patient satisfaction scale after 1 month was 42 (standard deviation=5) and 39 (standard deviation=8) after 3 months, which was not significantly different (p = 0.10). CONCLUSION: A nurse look-a-like avatar integrated into a telemedicine application was positively assessed by heart failure patients. Future studies are warranted to clarify the role of avatar technology in telemedicine.

Prognostic value of signs and symptoms in heart failure patients using remote telemonitoring.

INTRODUCTION: Heart failure is a serious burden on health care systems due to frequent hospital admissions. Early recognition of outpatients at risk for clinical deterioration could prevent hospitalization. Still, the role of signs and symptoms in monitoring heart failure patients is not clear. The heart failure coach is a web-based telemonitoring application consisting of a 9-item questionnaire assessment of heart failure signs and symptoms and developed to identify outpatients at risk for clinical deterioration. If deterioration was suspected, patients were contacted by a heart failure nurse for further evaluation. METHODS: Heart failure coach questionnaires completed between 2015 and 2018 were collected from 287 patients, completing 18,176 questionnaires. Adverse events were defined as all-cause mortality, heart failure- or cardiac-related hospital admission or emergency cardiac care visits within 30 days after completion of each questionnaire. Multilevel logistic regression analyses were performed to assess the association between the heart failure coach questionnaire items and the odds of an adverse event. RESULTS: No association between dyspnea and adverse events was observed (odds ratio 1.02, 95% confidence interval 0.79-1.30). Peripheral edema (odds ratio 2.21, 95% confidence interval 1.58-3.11), persistent chest pain (odds 2.06, 95% confidence interval 1.19-3.58), anxiety about heart failure (odds ratio 2.12, 95% confidence interval 1.44-3.13), and extensive struggle to perform daily activities (odds ratio 2.23, 95% confidence interval 1.38-3.62) were significantly associated with adverse outcome. DISCUSSION: Regular assessment of more than the classical signs and symptoms may be helpful to identify heart failure patients at risk for clinical deterioration and should be an integrated part of heart failure telemonitoring programs.