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‘A longer leash’ on life: Digital Implant Monitors Heart Patient at Home and on the Go

Mario Gutierrez, director of PHI's Center for Connected Health Policy, is interviewed in this article in Wisconsin's Kenosha News about remote monitoring of patients with chronic heart disease as well as other chronic conditions such as diabetes and hypertension. “The notion of telemedicine — in fields like psychiatry and radiology — has been around for 40 to 50 years; diagnostic, treatment and monitoring applications has emerged within the last 10,” Gutierrez said.

For many people with chronic heart disease, slowing down comes with the territory.

The nagging worry that they may need to visit the emergency department without warning puts favorite activities and travel on the back burner and keeps them tethered close to home.

Not long ago, that was the scenario being played out for Bristol resident Arlyn Wade.

Wade is an avid hunter and outdoorsman who likes to travel with his wife, Bernice. The 82-year-old also has chronic heart disease that over the course of time has put the brakes on his favorite pastimes.

Last summer, after three decades of wondering when his next trip to the emergency room might be, Wade received a new lease on life: a digital implant the size of a paper clip. The tiny piece of technology reads his vital signs and sends the data to his Milwaukee cardiologist. If an aberration is found, his physician, Dr. Nasir Sulemanjee, immediately orders adjustments to his medications or diet.

Traditionally, cardiologists use weight and blood pressure to determine the status of their heart patients, but these changes occur over time, and with heart conditions, time is critical, Sulemanjee said in a recent interview.

CardioMEMS, made by St. Jude Medical, is “a gauge inside the arteries” that detects a buildup of pulmonary fluids long before a person’s weight changes register on a scale or he or she experiences shortness of breath, Sulemanjee said.

“It is a revolutionary device,” Sulemanjee said. “In the heart failure world we have been searching for a signal to treat patients effectively; a signal to check the status of the condition and intervene immediately in real time.

“We thought weight and blood pressure readings were the way to go, but by the time (these things change) it’s often too late and patients are already in distress.”

For Wade, the device could not have come sooner. Over the years, Wade tried to maintain his normal activities, hunting, managing a landscaping business and taking care of two teams of horses he uses for carriage and sleigh rides, but repeated episodes of arrhythmia and weakness resulted in trips to the emergency room.

Wade had episodes of shortness of breath and fatigue and symptoms of heart failure even after receiving a pacemaker in 2011.

Last spring, despite his history of heart-related issues, Wade and his wife decided to take a trip to Ohio and Tennessee. Shortly before departing for the Kentucky Derby, Arlyn experienced heart failure symptoms that landed him a two-day stay in the hospital in Tennessee.

After he was stabilized, the couple returned home. By the time he checked into Aurora St. Luke’s Hospital, Milwaukee, his diagnosis was acute decompensated heart failure.

Sulemanjee suggested Wade consider CardioMEMS, a remote patient monitoring system approved by the Food and Drug Administration in 2014.

On Aug. 20, 2015, Wade’s chip was installed and he began working with the system. Every day he takes a reading by lying on a pillow with a sensor which is connected to a computer. The data feeds to his medical team in Milwaukee, which determines if his values are within parameters.

Numbers that aren’t quite right trigger a personal phone call to find out if Wade has changed anything in his diet or lifestyle. If not, Sulemanjee may call for an adjustment to his medications.

CardioMEMS responsiveness and real-time factors represent a new paradigm in heart disease management, said Sulemanjee.

“For the longest time we’ve been treating heart failure by prescribing the same medications every day because we assume patients will eat and drink the same every day.” Being able to document subtle daily changes allows patients to eat and drink a little differently, he said.

Wade knows this from experience. Keeping a meticulous daily log of his weight helps him understand when and why his CardioMEMS numbers shift.

The CardioMEMS technology has lived up to expectations, say the Wades. Three months after his implant, Wade went pheasant hunting in Whitewater and at Thanksgiving went deer hunting at his cabin in Antigo. Traveling now is as simple as packing up the very portable system and taking daily readings.

In the seven months since the implant,Wade’s numbers triggered an alert that resulted in an adjustment of medications, but did not require an emergency trip to the hospital.

“Even if we don’t go anywhere it’s a relief (to have the technology),” said Bernice. “It’s peace of mind.”

But going places is the best part, says Arlyn, who is looking forward to taking in a horse auction in Iowa later this month.

“I like to keep going … (the technology) gives me a longer leash,” he said.

Remote monitoring goes the distance to keep tabs on patients

It’s called “telehealth,” but it’s more like “Skype on steroids.”

Remote patient monitoring similar to the device used by Arlyn Wade is helping keep tabs on those with other chronic medical conditions such as diabetes, hypertension and chronic obstructive pulmonary disease.

It is also being used to monitor stroke victims, patients in intensive care units and to check in with those who use pacemaker devices.

“In broad terms, telehealth is defined as the use of electronic communication to provide cures and health education information from a distance,” according to Mario Gutierrez, executive director with the Center for Connected Health Policy. Operating under a grant from the U.S. Department of Health and Human Services, the center is a resource hub for emerging telehealth policy.

“The notion of telemedicine — in fields like psychiatry and radiology — has been around for 40 to 50 years; diagnostic, treatment and monitoring applications has emerged within the last 10,” Gutierrez said.

Remote patient monitoring has become very sophisticated, Gutierrez said. As an example, he cited senior living quarters wired to assess motion and the biometrics of the occupants.

In some rural areas, telemedicine is being used to enhance communication in trauma care. Called teleICU, an urban medical center becomes a hub that monitors intensive care units at rural hospitals. “The technology is so good we can monitor patients for any number of biometric measures,” Gutierrez said.

With video cameras, smartphones and other technologies, a program called telestroke allows stroke specialists to communicate remotely with emergency room physicians to evaluate patients who have had acute strokes, taking action before more damage occurs, Gutierrez said.

Telemedicine is also moving toward physicians and patients interfacing in “patient portals,” bypassing visits to the doctor’s office or walk-in clinic.

“If 60 to 70 percent of patients don’t need to be seen, then those who really need services can be seen,” said Gutierrez.

Such cost-effective treatment delivery is the wave of the future, Gutierrez said. “Telehealth is value-based care.”

Read the full article in Kenosha News.

Originally published by Kenosha News

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