Experience with 1000 Consecutive Remotely Monitored Patients: The Scale and Spread of Success

K. W.. Lobdell¹, S. Crotwell¹, L. Watts², T. Maxey³, B. LeNoir¹, E. Skipper⁴, R. Habib⁵, G. B.. Russell⁶, J. Frederick¹, G. A. Rose^1
1Sanger Heart & Vascular Institute, Charlotte, North Carolina ²Atrium Healthcare-Carolinas Medical Center, Charlotte, North Carolina ³Carolinas Health Care System Levine Childrens Hospital, Charlotte, North Carolina ⁴Carolinas Heart Institute & the Sanger Clinic, Charlotte, North Carolina ⁵The Society of Thoracic Surgeons, CHICAGO, Illinois ⁶Wake Forest School of Medicine, Winston-Salem, North Carolina

Purpose: “Perfect Care” (PC) enrolls patients into a remote monitoring program, which includes a digital health kit (DHK) and an application for appointments, biometric data, patient reported outcomes, audiovisual visits, & messaging. PC’s aims to improve postoperative length of stay (PLOS), 30-day readmission, increase patient’s time at home, and eliminate disparities.

Methods: PC enrolled 1000 consecutive adult coronary bypass (CAB), valve, or CAB + valve surgery patients in three hospitals July 2019 - March 2023. Our institutional Society of Thoracic Surgeons-Adult Cardiac Database was utilized to compare baseline characteristics, risk-scores, and outcomes. Fisher’s Exact Test was utilized for categorical measures & independent t-tests for continuous measures. Propensity scores (PS) were generated with PC as the outcome measure; the logistic model includes gender, age, BMI, LVEF, cardiac arrhythmia, DM, renal failure, systemic HTN, CVD, PAD, & STS predicted risk of mortality. Utilizing a nearest neighbor matching algorithm, PS were utilized to create a 1:1 non-PC: PC match for analysis, comparing balanced cohorts of 1000 PC patients & 1000 non-PC patients from the same three hospitals. P ≤ 0.05 was the criterion for significance in testing baseline & outcome measures. SAS (version 9.4) was used for all analyses.

Results: Favorable outcomes were noted in both non-PC and PC cohorts. The remotely monitored, PC patients have a statistically significant reduction in PLOS (1.1 days mean, 15% relative difference and 1 day median, 17% relative difference), 30-day readmission { 33 % relative difference & Odds Ratio 0.65 (IQR 0.44 , 0.95) }, and were more likely to be discharged to home when compared to matched controls (Table 1 and Table 2). No disparities in outcomes were noted between caucasians and non-caucasians in the PC cohort.

Conclusion: PC’s platform to remotely engage and monitor adult cardiac surgery patients (1000 with a variety of common procedures) is feasible at scale and has been spread to three facilities. The association of remote monitoring with improved outcomes suggests confidence in earlier discharge while simultaneously mitigating the risk of readmission, defying the “paradigm” of either longer stays or fewer readmissions. Hence, PC transforms the perioperative cardiac care experience and predictably improves outcomes without obvious disparities.

Identify the source of the funding for this research project: The Duke Endowment