Study tests feasibility of remote monitoring in PAH

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The researchers tested the feasibility of remote monitoring of patients with pulmonary arterial hypertension via smartphones and smartwatches.

Parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension (PAH), according to the results of a multicenter prospective observational study. However, some challenges remain. The results were published in Internet medical research journal.

PAH is a progressive disease that can lead to right heart failure and death, while iloprost is a prostacyclin analogue that can be inhaled using a nebulizer that tracks inhalation behavior.

“Impairment in quality of life in patients with PAH is severe, with health-related quality of life scores comparable to those reported for patients with unresponsive spinal cord injury or cancer. treatment, ”the researchers explained.

“The use of vasoactive therapy to treat PAH is generally guided by intermittent clinical measurements of 6-minute walking distance, World Health Organization (WHO) functional class, and blood levels. B-type natriuretic peptide (BNP) or pro-N-terminal. Type B natriuretic peptide (NT-proBNP). But these clinical measurements can only provide insight into a patient’s state of health as measured during in-person appointments. According to the authors, this creates an opportunity for remote monitoring of patients.

Continuous assessment of parameters such as physical activity can help researchers better understand the impact of PAH on daily life.

Using a commercially available smartwatch and smartphone, the researchers tracked the daily physical activity of patients with PAH starting treatment with iloprost. They also examined “the association between changes in numerical measures of physical activity and changes in traditional clinical measures of disease severity and health-related quality of life over a 12-week period. “.

Between February 2018 and July 2019, patients aged 18 or over were recruited from 7 PAH centers in Germany. Of the 31 patients screened, 18 individuals followed for a median duration (IQR) of 91.5 (88-92) days were included in the final analyzes. Initially, all patients were receiving oral therapy for PAH.

The researchers found:

  • Changes from baseline of traditional and digital 6-minute walking distance were moderately correlated (r = 0.57)
  • Physical activity (distance covered per day: median 0.4 [–0.2 to 1.9] km; number of daily steps: median 591 [−509 to 2413]) and clinical measurements (traditional 6-minute walking distance: median 26 [0-40] m) has changed consistently between baseline and the end of the observation period
  • The health-related quality of life has changed little
  • Total sleep score and resting heart rate decreased slightly
  • Distance traveled and number of steps showed short-term increases after each inhalation of iloprost

No new safety signal was identified (safety analysis set: n = 30)

“The results demonstrate the feasibility of using numerical parameters as numerical biomarkers for long-term activity levels in patients with PAH,” the authors wrote, adding that “although the correlations between changes in Numerical and traditional measures of clinical outcomes were few in number, the general directions of these changes were generally consistent.

A lack of available patients and a small subsequent study size mark a limit to the investigation, in addition to the fact that the numerical 6-minute walking distance algorithm was based on the stride length of healthy individuals as opposed to to those with PAH.

Overall, further research in this area, including studies with longer-term follow-ups, is warranted. “Numerical measurements of daily physical activity and traditional clinical measurements showed consistent changes from baseline after adding inhaled iloprost to oral PAH therapies,” the authors concluded. “The data indicate that activity tracking algorithms validated for healthy people require adaptation for patients with PAH.”

Reference

Stollfuss B, Richter M, Drömann D, et al. Numerical monitoring of physical activity, heart rate and inhalation behavior in patients with pulmonary arterial hypertension treated with inhaled iloprost: an observational study (VENTASTEP). J Med Internet Res. Published online 10 Aug 2021 doi: 10.2196 / 25163


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