Can Telemedicine Prevent Heart Attacks?
Heart disease is the number one killer in America. But could innovations in telehealth access prevent heart attacks? In this article, we’ll go through a typical patient scenario and explore how telehealth can benefit individuals. We’ll also talk about how access to healthcare is linked to heart attacks. Finally, we’ll review the American College of Cardiology’s recommendations for remote preventative care.
Portrait of a heart attack
Every day, a version of this story plays out in our country.
A 65-year-old man wakes up bleary-eyed from his recliner. He didn’t sleep well last night, as he hasn’t slept well for the last several nights. He groans as he rises from his chair. It’s the only place he can get any shut-eye since he has to use a breathing machine if he lies flat.
He slips into house shoes and shuffles into the kitchen. The coffeemaker grumbles out a black kettle of coffee. He takes his cup to the back porch, along with his breakfast cigarette. Milky tobacco smoke blooms into the morning air.
He looks out across dewy fields, contemplating the day ahead.
Despite the cool morning, he is sweating. He feels exhausted thinking of what he needs to do today and considers going back to his recliner. The spent cigarette butt shakes in his fingers.
He sits on the step, suddenly lightheaded.
His chest feels tight. A clenching fist wrapped around his insides, then he reached up and grasped his jaw with pain. Is that his heart pounding in his ears? It’s so loud, it could be a helicopter.
With a terrible dawning recognition, he realizes he needs help. He scrambles from the porch step, lurching into the kitchen to yank the phone from its seat. His hands tremble as he dials 9-1-1, voice fearful on the phone. He’s so short of breath, he gasps between words with the operator. He doesn’t want to be alone right now.
Thankfully, he only has a few minutes before EMS arrives. They reassure him, carrying him to the ambulance where they’ll take him to a hospital. He lives, but he carries fear in his chest for the rest of his life.
This is a frightening and common event in America. This story is fiction, but his story is happening every day, right now. In fact, according to the American Heart Association, an American suffers from a heart attack every 36 seconds.
But could this man’s heart attack, and so many others, be prevented? Could heart disease be one of the many illnesses we can combat with digital medicine?
The facts on heart health in America:
- Cardiovascular disease (CVD) is the leading cause of death for Americans.
- 1 in 4 deaths is associated with heart disease.
- The average age of a first heart attack is about 65. Out of those who die of coronary artery disease (CAD), 20% are under 65.
- Hypertension is a contributing factor in many heart attacks. It’s estimated that nearly half of all Americans have hypertension.
- The American Heart Association estimates that heart disease costs America nearly $1 billion per day.
- The CDC estimates that 80% of heart disease deaths are preventable.
Heart disease and healthcare
The most promising fact about heart disease is how preventable it is. We know that a healthy diet, exercise, and health monitoring can stop heart disease before it progresses.
But this also means that when we talk about heart disease, the burden of blame gets put on the individual. We say they should have stopped smoking, should have managed their medications, and should have eaten better. We see people making these decisions without understanding that they lacked access to health care in the first place.
The truth is that a person’s access to healthcare has a lot more impact on heart health and determines how they receive care and care for themselves. More and more, we are beginning to understand how a lack of proper care impacts the lifespan of Americans.
Socioeconomic status and healthcare access affect the health of millions of Americans. Disadvantaged people are more likely to develop heart disease and tend to suffer more because of it. In fact, socioeconomic status is now thought to have as much of an impact on health as other risk factors, such as smoking and obesity.
Heart disease prevalence signals how our healthcare system has failed people.
The doctors are doing their best. But keeping up with patients gets harder before in-person visits become dangerous again. And tracking hundreds of patients at a time can leave physicians stretched too thin to give quality care. Often, it’s the patients who have the least access to care who need it the most.
Could increasing access to preventative remote care stop countless deaths from heart disease?
We think so.
How can telemedicine prevent heart attacks and heart disease?
The American College of Cardiology (ACC) is enthusiastic about using telemedicine to prevent and treat heart disease. They recommend several strategies that can benefit people across their lifespans. These include lifestyle counseling, encouraging medication adherence, supplying refills, modifying risk factors, and preventing disease progression.
Let’s explore how each of these interventions could have prevented our friend’s heart attack.
Lifestyle counseling for heart disease
Telemedicine offers an opportunity to give personalized lifestyle coaching. Promoting exercise, diet, and lifestyle modifications is a great way to use telemedicine as preventative care. With remote care, providers can see into patients’ real lives to understand their specific challenges. Patients and doctors can go through medications and supplements in real-time, rather than relying on memory.
Keeping track of progress is much easier for patients and providers with scheduled telehealth sessions. Increased accountability and accessibility to counseling can help keep patients on track. The ACC says, “The integration of [mobile health] into CVD prevention practices has the potential for widespread impact on patient outcomes and clinical research.”
The man at the beginning of our story would have benefited from ongoing remote care. Telehealth could have given him a relationship with a physician. He would have benefited from counseling about his breathing machine as well as his diet and stress. He could have understood how his behaviors affect his health and had a better outcome in the long run.
Managing medication refills and adherence
As we go into another phase of social distancing, telemedicine can help make sure that patients are still getting the prescriptions and medication management they need. What’s more, telemedicine can use the whole medical team, whereas a one-on-one visit cannot. Without leaving their home, people can see their primary physician, dietician, pharmacist, and more.
Our friend should have had remote medication counseling. This would have helped him understand his regimens better and keep his risk of medication interactions low. Dietary consultation could have also helped him understand which foods increase his heart disease risk and which ones lower it.
Modifying risk factors for heart disease and preventing CVD progression
Telemedicine offers the opportunity to identify patients who are at risk of CVD. It can also give them the tools to change their lifestyles and lower their risk of further illness.
One 2016 study showed that patients at high risk of CVD could lower their risk factors with telehealth. These people felt more supported and empowered with digital health consultations. Patients in this study were able to lower their blood pressure and weight. They also felt more confident in understanding their medications and lifestyle risks.
Remote monitoring is another way to keep track of patients from afar. Blood pressure and heart rate monitoring can keep patients accountable. Providers can also track their progress day-to-day without losing time with other patients.
This man in this story could have felt supported by a network of remote health professionals. He could have gained control and understanding of his own health. Remote tracking of his blood pressure and cholesterol levels would have helped him see his own progress while staying on track.
He could have had better access to care at the best time; before he got sick.
The good news is that it’s not too late for our friend. By accessing remote medicine, he can still take back control of his health and prevent future heart attacks.
Telemedicine and America
As hospitals filled with a new wave of COVID, people with chronic illnesses like CVD faced lapses in care. In the last wave, there was a sharp decline in preventative care and screening. What’s worse is that the rebound of visits after these waves did not make up for the lost care opportunities. People who missed out on routine health checks got sicker because of it
We have an opportunity to do better for these people. We can break through barriers of time, location, and safety. We can catch patients before they develop heart disease, and better manage patients who already have it.
Medicine has a duty to rise to this occasion by implementing better remote preventative care. To quote the American College of Cardiology, telemedicine is “a rare opportunity to improve care delivery”. By meeting people in their homes, we can impact their lives in ways traditional medicine cannot. By stopping heart disease in its tracks, we can save people from heart attacks before they even happen.