Telehealth for heart patients

At some point, the first symptoms set in. “I was always tired. My legs and hands hurt,” says Francisco Antonio Rosa, who is seated on the garden terrace of his family home in Lisbon. He didn’t know what was wrong. “I had always been healthy and full of energy,” says the 84-year-old.

Despite his advanced age, Rosa was still managing his pastry shop (the well-known Pastelaria Dâmaso in the Avenida de Roma in Lisbon) every day from morning till night, up until six months ago. “The contact with my regular customers has always been very important to me,” he explains. But suddenly his health didn’t allow him to work anymore. Medical examinations revealed that Rosa had a heart valve defect. His cardiologist recommended that he seek treatment from Portugal’s renowned interventional cardiology specialist, Professor Lino Patrício, who worked at the Hospital de Santa Marta in Lisbon. That sounded perfect, as Portugal’s largest university hospital is right next to Rosa’s home. The problem was that Patrício was no longer working at the site.

<p>He had moved to the Hospital do Espírito Santo de Évora (HESE), a hospital in the rural Alentejo. Here, in the country’s interior, around 150 kilometers from Lisbon, Patrício is working with Siemens Healthineers to develop one of the most modern and innovative interventional cardiology centers in the country. Thanks to its <a href="long-term-partnership" target="_blank">long-term partnership</a> with Siemens Healthineers, the integrated cardiovascular center in Évora not only boasts telemedicine solutions and consulting services for process optimization, but also the latest imaging technologies. This meant that Patrício and his team could perform transcatheter aortic valve implantation (TAVI) on Rosa. The procedure involves implanting an aortic valve into the beating heart via a catheter and without general anesthesia. HESE has the only cath lab in the south of Portugal and outside of Lisbon that can use this minimally invasive technique in heart surgery.</p>

<p>This is an innovative technology that Rosa could trust. He says he felt that he was in good hands even before the intervention. Although Lisbon and Évora are relatively far apart, the <a href="telemonitoring" target="_blank">telemonitoring</a> system meant Rosa was in permanent contact with Patrício’s team even before he underwent surgery. Every morning for many weeks, he used the devices he had been loaned to record his weight, blood pressure, blood SpO2 levels, and heart rate. He then sent the data using a smartphone app to HESE, where three clinical staff members are assigned exclusively to evaluate patients’ vital signs.</p>

“To begin with I needed the help of my son, Nuno. But the devices and app are very easy and intuitive to use,” says Rosa. As a precaution, though, his wife Maria Lurdes was always with him when he took and sent the clinical measurements. Whenever there was a deterioration in some key parameters, he received a call from a telehealth coordinator or his physician from Évora. “That gave me confidence and security,” says Rosa. Remote monitoring of his health prior to the operation also made his everyday life easier. “Because that way I didn't have to constantly go to my cardiologist or even to the hospital in Évora to check my health status, which I would have been reluctant to do during the COVID-19 pandemic,” he says.

On the morning after our interview, nurse Marisa Serrano prepared Rosa for surgery while Patrício and his team of physicians studied the latest images of his aorta and arteries in the neighboring room. Rosa was happy that the time had finally come: “I want to get my quality of life back, play with my three grandchildren, and finally be able to go for a walk again with my dog Max.”

<p>For Constança Pires, this dream is already a reality. In mid-August, Patrício implanted a new valve in her heart using the&nbsp;<a href="TAVI%20procedure" target="_blank">TAVI procedure</a>. “After a few days I was fit again and I have since been able to lead a relatively normal life,” says the 79-year-old from Evoramonte.&nbsp;She’s a little annoyed with herself that she waited almost five years. “It got to the point where I could hardly leave the house, I had so little strength.” Her garden with its olive and citrus trees lay untended. She and her husband Lúcio could no longer take care of it. Shopping and cooking were also difficult for her. For a long time Pires resisted a heart operation out of fear that her ribcage would have to be opened. However, when she had another dizzy spell in July and was told about the TAVI procedure and telemonitoring that was now available at HESE, she finally consented to the intervention.</p>

Pires’s granddaughter helped her to collect her data and send it via smartphone. The remote health monitoring before and after the intervention had several advantages for her: She didn’t have to visit the hospital regularly for preliminary and follow-up examinations during the COVID-19 pandemic, and it saved her a lot of time and money. Evoramonte, a small community of 500 people, is only 30 kilometers from Évora. Yet people living in the villages of the sparsely populated region are effectively isolated if they don’t have a car. The Alentejo region occupies a third of the area of Portugal, but just 700,000 people live here. That is 22 people per square kilometer. Intercity buses only run to Évora twice a day. “And a taxi for the return trip would have cost me €70 each time,” says Pires, who, as a former plantation worker, does not have a large pension. For her, telemedicine is a blessing – both in health and financial terms.