Feasibility of a noninvasive heart failure telemonitoring system: A mixed methods study

Teemu Ekola, Vesa Virtanen, Tuomas Koskela

Keywords: heart failure, telemonitoring, telemetry, remote patient monitoring, telemedicine, feasibility study, mixed methods

Background:

Heart failure is a global health problem with an increasing prevalence and burden to patients and healthcare systems. It affects especially older people with multimorbidity. Noninvasive telemonitoring might reduce mortality and heart failure hospitalizations. Feasibility is an important factor regarding patients’ adherence to and the success of implementing telemonitoring programs.

Research questions:

We aimed to examine the feasibility of a noninvasive telemonitoring system used by heart failure patients and nurses in two Heart Hospital units and one health center in Finland.

Method:

This cross-sectional observational study used a mixed methods design. Quantitative data were collected with one self-generated questionnaire for patients, and qualitative data were collected with a questionnaire for patients and semi-structured focus group interviews for patients and nurses. The questionnaire was sent to 47 patients in the pilot program of telemonitoring, and 29 patients (61.7 %) responded. Purposefully selected 8 patients and 8 nurses attended the interviews. We used descriptive statistics to assess the quantitative data from the questionnaire and inductive thematic analysis to identify themes deriving from the focus group interviews. We categorized the themes into facilitators and barriers to telemonitoring.

Results:

Both the quantitative and qualitative data show that the telemonitoring system is easy to use, supports self-care and self-monitoring, and increases the feeling of safety. The system’s chat tool facilitated communication between patients and nurses. The participants considered the system reliable despite some technical problems. The focus group interviews addressed technical challenges, nurses’ increased workload, and patients’ engagement with daily follow-up as possible barriers to telemonitoring.

Conclusions:

The studied noninvasive heart failure telemonitoring system is feasible. It seems suitable for monitoring heart failure patients also in primary care. We found facilitators and barriers to telemonitoring that should be considered when developing and expanding the noninvasive telemonitoring of heart failure in the future.

Points for discussion:

The importance of asynchronous communication (chat tool) for patients and nurses.

Telemonitoring increases the feeling of safety -> less contacts to healthcare?

Telemonitoring requires engagement with daily follow-up -> treatment fatigue?

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