Telehealth for your heart

Seeing and speaking with a doctor via smartphone, tablet, or computer from the comfort of your own home became commonplace during the height of the COVID-19 pandemic. Over the past year or so, in-person health care visits have rebounded. But video visits and other forms of telehealth can still be a good option for treating people with heart disease, according to a scientific statement from the American Heart Association (AHA), published Dec. 20, 2022, in Circulation.

"What we're seeing now is an increase of blended care that includes a combination of in-person and virtual visits," says cardiologist Dr. Ami Bhatt, associate professor of medicine at Harvard Medical School and chief innovation officer for the American College of Cardiology. Health care systems that established infrastructure to integrate virtual health care into their practices have had the most success with a hybrid model. For both patients and clinicians, it's important to pay attention to specific needs, preferences, and comfort level with different types of care, she says.

Types of telehealth

Telehealth can be delivered in any of three ways:

• synchronous — when the doctor communicates with the patient in real time via phone or an Internet-connected device
• asynchronous — when information is exchanged between doctors and patients but not in real time, similar to e-mail communication
• remote monitoring — when measurements such as weight, blood pressure, or a simple electrocardiogram (ECG) are sent to the clinician through wirelessly connected devices.

Even before the pandemic, most medical practices already had Internet-based portals that people used to make appointments and receive test results. These portals often serve as the gateway to synchronous visits, which are ideally suited for much of the care needed by people who have or are at risk for heart disease.

For example, doctors often review information from various measurements or tests you've done at home (such as weight, blood pressure, and blood sugar readings) or from a lab (a cholesterol test) and then discuss any lifestyle or medication changes you can make to better manage your condition. Many studies have shown that telehealth care can lead to significant improvements in heart-related risk factors, especially lowering blood pressure, as the AHA statement notes.

Currently, async="async"hronous communication between doctors and patients tends to originate from the medical practice and usually includes things like questionnaires or reminders about screenings or tests. But if people shared information through a portal prior to a virtual visit, that would leave more time for discussion, Dr. Bhatt says.

Remote monitoring

For people with heart failure, a smart scale that wirelessly transmits data can flag small weight increases that may signal the need for medication adjustments. Other options for monitoring include smart watches or other devices that track your heart rate and check for heart rhythm abnormalities with a simple ECG, which you can then pass on to your physician. But while doctors are becoming comfortable prescribing these digital tools, they're not a smart choice for everyone. "These days, there's a lot of health-related anxiety, and overmeasuring can contribute to this problem," says Dr. Bhatt. Make sure you understand when, why, and how often self-monitoring makes sense for you, she advises.

The right blend

People with heart disease who need routine check-ins often appreciate the convenience of virtual visits, which eliminate travel and waiting time. "But there are times that sitting together in the same room is best, even when you don't need a physical exam," says Dr. Bhatt. Finding the right blend of telehealth and in-person care is the future we're slowly moving toward, she says.

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