Guidelines in cardiology continue to evolve as technology and research advance. Cardiologists from two leading health systems in the U.S. spoke to Becker's about their reactions to recent guideline updates.
Remote patient monitoring
The American College of Cardiology published the "Remote Patient Management Workbook" July 31.
The workbook provides recommendations on managing cardiac care when utilizing direct-to-consumer devices as remote monitoring tools.
It includes guidance on how to set up a remote patient management program as well as insights that can help providers decide if their practice is ready for remote patient management.
Ilan Kedan, MD, of the Smidt Heart Institute at Cedars-Sinai in Los Angeles, told Becker's he congratulates the ACC for "initiating and framing a conversation about remote patient monitoring in the context of clinical management cardiac health and cardiovascular disease."
Dr. Kedan raised a few concerns regarding the time and resources needed for addressing daily error and alert messages as well as for data collecting, processing, security and storage. He questioned the effect those costs will have on a program's overall benefit.
He also questioned how a remote monitoring program may influence the physician-patient relationship.
"In the ever-increasing demand for personalized and individualized care, focusing on metrics and RPM data may potentially distance the clinician and care teams from patients' human experience," Dr. Kedan said. "I believe it is always important to consistently leverage novel technologies with a virtuous goal of relating to the human experience and aspiring to alleviate human suffering. Collecting information from patients remotely, and in the absence of direct human contact, warrants mission-driven language as a guide for framing the use of this technology."
PREVENT risk calculator
The American Heart Association released the PREVENT risk calculator Nov. 10. The calculator can estimate the 10- and 30-year cardiovascular disease risk for people 30 and older.
A study published July 29 in JAMA found that 14.3 million patients could be found ineligible for statin therapy under the PREVENT calculator equations.
There has not been any recommendation to replace the widely used pool cohort equation prediction tool with PREVENT, but the AHA has proposed including it in future guidelines.
Gary Oppenheim, MD, of Providence Swedish Health Services in Seattle, told Becker's the PREVENT equation will be a significant improvement over pooled cohort equations but added that future monitoring will be needed "to verify whether it truly improved predictability."
While he said the equation likely will lower the number of patients eligible for statin use, he added that pooled cohort equations may have overestimated the need for statins and that the PREVENT equation was developed for a more "contemporary" population.
He said while the PREVENT equation will ultimately need to be incorporated into current ACC and AHA prevention guidelines, there needs to be further study on its accuracy.
"Predictive equations are a starting point for a conversation between a patient and physician regarding risk assessment," Dr. Oppenheim said. "[Equations] cannot provide a highly customized risk assessment for an individual patient, which requires assessment of other risk factors."