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A new smartphone app called Medly, developed at UHN, is changing how heart failure patients at the Peter Munk Cardiac Centre and the Ted Rogers Centre for Heart Research manage their own symptoms and reduce visits to the hospital – all while continuing to receive clinical care. (Photo: Mediaplanet)

The main reason why Canadians are admitted to hospital may surprise you.

The culprit is the fastest-rising cardiovascular disease in this country – heart failure – the inability of the heart to pump enough blood to meet the needs of the body.

"About one million Canadians are living with heart failure and about 300,000 of those patients are in Ontario," says Dr. Barry Rubin, Medical Director of the Peter Munk Cardiac Centre (PMCC).

That number is expected to increase by about 25 percent over the next 20 years.

Ensuring optimal care to this growing population of patients is among the most vexing challenges facing healthcare professionals working in cardiovascular medicine. Heart failure patients typically see their cardiologists twice per year. Between these visits, doctors remain unaware whether symptoms are worsening and patients are left guessing about the health of their heart.

New digital tool monitors patients remotely

A new digital tool called Medly seeks to provide patients with self-care and coordinated clinical support, all without leaving their homes.

"Not only does Medly keep patients continually connected to their healthcare team, it also assists healthcare providers in supplying the right care at the right time and helps to avoid costly hospital readmissions," says Dr. Heather Ross, who heads the Ted Rogers Centre of Excellence in Heart Function at the PMCC, and has been instrumental in Medly's successful deployment.

Developed by Dr. Joseph Cafazzo, a biomedical engineer, researcher, and educator at eHealth Innovation, a partner of University Health Network, the Medly app enables patients to record and store their physiological measurements (such as blood pressure, heart rate, and body weight) and symptoms via the Medly app. Medly runs this data through a clinically-validated algorithm (a set of rules to solve a problem) which provides instant feedback to patients and their clinicians.

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Heart failure patient John Punshon takes his own blood pressure cuff at his home in Peterborough. Obtaining a blood pressure reading is part of the data that patients using Medly must enter to ensure management of their symptoms, remotely. (Photo: Mediaplanet)

The Medly system is part of the PMCC's digital cardiovascular health platform and has been integrated into the centre's care for heart failure patients.

"This will revolutionize our ability to streamline care, prioritize, reduce errors, and provide real-time, up-to-date prognoses, and treatment plans," says Dr. Ross.

While currently used for cardiac monitoring, researchers expect Medly's evolution to focus on reaching new populations of cardiac patients (with multiple chronic diseases) and scaling the product within Ontario.

"We're making investments in this area because we believe that remote patient monitoring is the single most important change in healthcare that will improve outcomes that we're going to see in our lifetime," says Dr. Rubin.

Linking medicine and artificial intelligence

The PMCC has forged a partnership with the University of Toronto's Vector Institute for Artificial Intelligence (Vector) to integrate big data and machine learning algorithms into cardiac care. Physicians and surgeons at the PMCC will interact with Vector data scientists and software engineers to integrate machine learning into three specific areas of the hospital — research, individualizing patient care, and hospital operations.

This initiative is supported by generous donors to the Peter Munk Cardiac Centre Campaign, and is a key fundraising priority for the centre moving forward.

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A heart rate reading is one of the key criteria that a patient can take and store on their own, through the Medly app. That data is then transmitted in real-time to clinicians to help manage a patient’s heart failure symptoms while they are home. (Photo: Mediaplanet)

"The ability to have business intelligence-type tools that would help us to predict tomorrow's hospital environment will improve efficiency and the use of our precious healthcare resources," says Dr. Rubin.

Medly's greatest strength may be its ability to help manage patients with heart failure who are in remote locations in Ontario, and do not have rapid access to healthcare.

So far, patient feedback on Medly has been overwhelmingly positive.

"The vast majority love it," says Dr. Ross. "Patients feel empowered having this feeling of a safety net, and a sense that the doctor is always there."

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