Home Monitoring for Heart Failure: About TIME

Melissa K. Walton-Shirley, MD; Ileana L. Piña, MD, MPH; Clyde W. Yancy, MD, MSc


October 15, 2013

In This Article

The Ideal Monitoring Device

Dr. Piña: And very often the educators are not us. The better educators are the nurses and the pharmacists. The pharmacists are fabulous educators, and they can spend a lot more time with the patients than the 8 minutes that we have, which is why we have incorporated them into our early brown bag clinic.

Dr. Yancy: I'm concerned that some of the educators are a drop-down menu with a print out that gets put in a patient's hand.

Dr. Piña: Not the person-to-person contact. You can't get away from the person-to-person contact. It makes such a difference.

Dr. Yancy: There are some interesting data that we have in our guidelines, the 2013 guidelines, that demonstrate that it takes about 60 minutes of one-on-one intense instruction to really accomplish meaningful patient education. I am more worried about accommodating that kind of a service in the contemporary healthcare model than building a whole new infrastructure to grab data points that come in from the field, transmissions from devices. I would much rather have that core group of nurses who are providing the education. I think that will give our patients a best possible outcome.

Dr. Walton-Shirley: I have one quick question for both of you guys before we end this conversation. If you had in mind an ideal device that could monitor and transmit information to you, what do you think it should contain in order to do your best job to manage that patient on an outpatient basis? And I am talking about let's just go right into the future.

Dr. Yancy: It would be a dedicated, focused heart failure nurse -- I kid you not -- or a community worker who can serve as a reasonable surrogate. We really need to have a person involved. Unfortunately, we can't dumb it down. We have to realize this is an important disease that needs engaged people with enhanced awareness in order to drive the best outcomes. So whether it is next year or the next decade or the next century, I think we need dedicated people in the process.

Dr. Walton-Shirley: Ileana, do you agree?

Dr. Piña: Team care. Team care with dedicated professionals. I agree. We always have [this] in heart failure programs, without any fancy equipment -- that nurse on the phone with that patient makes a huge difference.

Dr. Walton-Shirley: And this makes a great team as well. Thank you so much for joining us today on

Dr. Yancy: Thank you, Melissa.

Dr. Piña: My pleasure. It's always good.

Dr. Yancy: So we had one or two opinions.

Dr. Walton-Shirley: That is why you are here. Thank you.


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