Upgrading Care

Corresponding Author

Compared to traditional models of care, digital DMPs showed a 32% risk reduction in all-cause readmissions (RR: 0.68, 95% CI: 0.51-0.91,96 fewer events), and a 45% risk reduction in cardiac readmissions (RR: 0.55, 95% CI: 0.44-0.68,58 fewer events).The RR of emergency department visits was also reduced by 63% (RR: 0.37; 95% CI: 0.26-0.54,42 fewer events).Digital DMPs did not differ with  Understanding the right patient, the appropriate scenario, and the relevant technology will be critical and should be the focus of research moving forward.
We will also need to examine the impact on the patient experience and clinician workloads.To ensure meaningful improvement in care, digital cardiology approaches should be rooted in thoughtful design and integration of evidence where feasible (Figure 1).
Implementation will require significant team-based efforts and financial investment, but there is considerable potential to improve patient care on a large scale.

FUNDING SUPPORT AND AUTHOR DISCLOSURES
The author has reported that he has no relationships relevant to the contents of this paper to disclose.

D
uring the height of the COVID-19 pandemic, I met a new patient 'in clinic' via video consultation after an intensive care unit stay and discharge a few days earlier.He was a 62-year-old South Asian immigrant who presented with an acute myocardial infarction requiring percutaneous coronary intervention and hospital course complicated by coronavirus infection, pulmonary embolism, and cardiomyopathy.The patient was discharged home with remote monitoring using a tablet linked to a bluetooth-enabled blood pressure cuff, pulse oximeter, and scale.I assessed him weekly by telemedicine, conferencing both his adult children into video meetings from separate locations.Care coordination with his home nurses and therapists took place via the electronic health record.Eventually, we enrolled him in a virtual cardiac rehabilitation (CR) program to complete his recovery.There are numerous such anecdotes of tech-enabled care from the pandemic.Remote management of patients using digital health-telemedicine, mobile health, wearables, and information technology-has been exciting, informative, and at times trying.While these programs are gaining attention, there are limited data on the impact of these strategies on patient outcomes and costs.Further investigation is needed to guide meaningful design and large-scale implementation.In this issue of JACC: Advances, Carrington et al 1 review the evidence for digital health strategies to reduce cardiovascular risk.They performed a meta-analysis of digital health enabled disease management programs (DMPs) for patients after a coronary artery disease related hospitalization.The investigators pooled data from mostly randomized control trials comparing traditional postdischarge DMPs to care interventions utilizing elements of digital health technologies (or 'mHealth' as denoted by the authors).The primary outcomes were rates of hospital readmission and mortality.A patient DMP was defined as 'a coordinated healthcare plan to help manage their disease better'.The majority of control interventions were traditional phase 2 CR programs including patient education and exercise guidance.Digital health interventions were broadly defined as DMPs implemented with 'the use of wireless communication devices and/or software technology.'These interventions were diverse including a combination of remote vitals and activity monitoring, texting interventions, and video consultations.The analysis included 18 trials and 3,818 patients spanning North America, Europe, and Australia from 2008 to 2021.Patient follow-up ranged from 1 to 24 months with most studies (n ¼ 13) reporting outcomes for <6 months.The typical DMP intervention lasted 3 to 6 months.
relationship.Hopefully, in time, we will generate data to confirm that these tools translate into improved outcomes.
Eberly LA, Chokshi NP, Adusumalli S, et al.Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic.JAMA Netw Open.Guiding Principles for Future Design of Digital Cardiology Programs