Currently, there are numerous remote patient management technologies in both inpatient and outpatient care services, including a few select that have had very positive outcomes. One such proficient home management technology is the Latitude NXT. The Latitude NXT 6.0 was launched in 2016 and lets caregivers manage patient’s implant device data between successive scheduled appointments, leading to improved efficiency and quality patient care.
Technology Details
Latitude NXT remote patient management system is a combination of a communicator, a secure online web portal, a blood pressure monitor, and an optional weight scale that enables health professionals to monitor cardiac device patients remotely through wireless connectivity and interrogations.
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The Implanted Device
The heart failure diagnostic capabilities are made possible by the HeartLogic component of Latitude NXT 6.0. HeartLogic is an implantable cardiac device- a multisensory heart failure index and alert algorithm. HeartLogic is sensitive enough to detect low heart burden and signal early warnings for worsening heart failure, with a 70% sensitivity and can predict a heart failure within a median 34-day advance before the heart failure event occurs ( Boehmer et al., 2017) . To achieve this, HeartLogic is engineered to use multiple sensors that track physiological processes and trends, then combines them into a composite index that conveys a proactive alert of a potentially worsening heart failure ( Gardner et al., 2018) . The physiological conditions monitored by the HeartLogic sensors include activity, heart rate, respiration, thoracic impedance, and heart sounds ( Boehmer et al., 2017) .
When the increased risk of heart failure events is detected earlier during the low-risk periods, healthcare professionals can focus the health resources on patients at higher risks of heart failure.
The Website
The Latitude NXT website is secure and is designed to provide high flexibility for the cardiac care personnel to conveniently access patient data remotely. The website also archives patient data so that the caregiver can keep track of the patient’s progress over time. The flexibility of the website further enables collaborative care between physicians. In this context, one physician can be monitoring the patient’s implanted device while another physician monitors the patient’s heart condition ( Boston Sceintific, 2019) . The multiple options are made possible by the separate configurations for alert and schedule configurations that are sent to clinicians upon request.
The Communicator
The communicator is a device used by the patient to set up communication between the patient and the physicians. These devices are always under the possession of the patients at their homes, from where the patients can set up automatic daily monitoring for transvenous ICDs, CRT-Ds, pacemakers, and CRT-Ps ( Boston Sceintific, 2019) . The communicator automatically conducts wireless alert checks or remotely scheduled follow-ups, which may also include configurable interrogations initiated by the patients themselves. Usually, the device operates via multiple connectivity options, including internet, cellular, and landline ( Boston Sceintific, 2019) . Information and user directions for using the Latitude NXT communicator are provided in the MyLatitude Patient App. Patients can access the app to find answers to their questions about the Latitude NXT technology, including set up and troubleshooting options for the system ( Boston Sceintific, 2019) .
Weight Scale and the Blood Pressure Monitor
These are easy-to-use external sensors that connect wirelessly to the communicator to enable the caregiver to monitor the weight and blood pressure of the patients remotely. The caregivers may review the configurable weight alerts to identify the patients in need of extra attention.
How the Latitude NXT 6.0 Technology Operates
The implant (HeartLogic) collects the patient information as programmed by the technology vendors. The Latitude Communicator checks the implant based data as scheduled by the doctor. While the implant may be continuously monitoring the health status, the communicator does not conduct continuous monitoring; rather, it monitors in intervals as programmed the doctor. The communicator can automatically send the data to the doctor or prompt the patient to send the data manually at scheduled times. The data from the communicator is then sent directly to the Latitude NXT website for physicians to review. Latitude does not make changes to the implant or reprogram it. This means that a malfunction in the communicator does not inhibit the implant from functioning continuously.
Notably, the communicator cannot contact external emergency services such as 911 in case of a health emergency. It is upon the patient to call 911 in case the patient feels that their conditions are deteriorating. The system uses advanced security mechanisms for protecting patients’ medical information. The information is open for access by authorized healthcare providers only.
Current Implementation of the Technology
The options for using Latitude NXT to monitor patient conditions were first rolled out in the United States. Saint Luke's and Roosevelt Hospital Center in New York is the earliest facilities to implement the connected technology on their patients. The application of Latitude NXT in remote patient monitoring of patients with cardiac arrests has shown tremendous improvement in patient outcomes along with profound economic benefits. Saxon et al. (2010) had earlier predicted that these values are realized because of the patient utilization capabilities and the optimization of the workflow when using the technology.
The implementation of patient management usually commences immediately after the implant gets into the body, a strategy that has enabled early clinical intervention and improved outcomes. Most caregivers and the patients have attested to having started realizing the benefits of in-home cardiac monitoring as early as one day after they got started on the program. Once started on the Latitude NXT, studies have revealed that the in-home monitoring can double the chances of survival for a heart failure patient ( Mittal et al., 2014) . To add on, Mittal et al. (2016) researched the application of HeartLogic on cardiac patients and revealed that those under in-home remote management had 50% more chances of survival as compared to those who did not rely on the in-home remote management system.
Cost Savings or Quality of Outcomes?
The implementation of Latitude NXT is a vital tool in health management, as it reduces both the costs of healthcare and leads to improved outcomes. Regarding costs, heart failure ranks atop the largest contributors to Medicare spending on potentially preventable re-admissions. The total annual cost for both direct and indirect heart failure treatments is about $34.4 billion ( Abbott, 2018) . The estimated annual cost on such preventable re-admissions for heart failure patients’ sums to approximately $ 600 million ( Abbott, 2018) . However, medical audits show that patients with remote monitoring cost less to manage the health care system. Patients with pacemakers have had a 9% reduction in heart failure expenditure while those with ICD/CRT-D, HeartLogic included, have had a 17% reduction in total spending over the last three years (Abot, 2018). These cost reductions when the patients are under in-home monitoring indicate the significance of technologies such as Latitude NXT in cutting down the already high cost of cardiac management.,
Proper utilization of remote technology has also streamlined the clinical operations in three notable ways, thereby improving patient conditions. The table below contrasts the value of the in-home remote management using Latitude NXT with a clinical practice that does not utilize any in-home remote management.
| No in-home remote patient management | Latitude NXT in-home patient management |
| Patients have routinely missed scheduled checks that require their involvement due to personal commitments | The device clinic routinely take control of the scheduled data transmission for the wireless communicator. |
| Clinical staff usually spend time communicating with or calling patients who do not get actively involved with their medical follow-ups | The active level of the wireless connection enables the patients to help the clinical staff in focusing on patient care. |
| Clinical staff consumes a lot of time entering patient health information in the database, printing it, and scanning. | The data received from the communicator automatically undergoes through the archiving processes. The automation reduces redundant data entry and the associated data entry errors. |
Disadvantages of this Technology
The first obstacle to the use of Latitude NXT is limited accessibility. The technology requires good broadband connectivity- one that is not easily achievable for small healthcare institutions or hospitals within the rural set-up. The application of these modern gadgets is also a charge for the older population, who might have trouble in the manual operation of the Latitude NXT communicator. The second obstacle is patient skepticism. Most patients do not have access to the data about their health that gets transmitted wirelessly from the communicator to the physician websites. As a result, a majority of the users have remained skeptical about the application of this technology. The patients’ skepticism has led to slower rates of recognition of RPMs, which in turn has led to minimal improvements in chronic disease management using the technology. Last is the concern on reliability. The sensitivity of HeartLogic currently stands at 70%, implying that there are up to 30% error margins ( Gardner et al., 2018) . Such a wide range of error raises questions on the possibility of imprecision in predicting the risk of heart failure. Thus, there remain considerable levels of uncertainty regarding the reliability of Latitude NXT pro.
Conclusion
In sum, in-home patient monitoring utilizes wireless technology to gather health data from patients at their homes and electronically transfers the data securely to a healthcare provider in a healthcare facility for assessments and recommendations. This strategy has been adopted in the creation of Latitude NXT 6.0, whose application has enabled physicians to remotely track cardiac health data for patients once that are released to their homes. It has contributed to significant reductions in re-admission rates while also containing the costs of care for heart failure. The monitoring program has kept people healthy, allowing the older and disabled patients to live at home longer and minimize their movements to skilled nursing facilities.
References
Abbott. (2018). Remote Cardiac Monitoring Portfolio | Abbott Cardiovascular . Index. https://www.cardiovascular.abbott/us/en/hcp/therapies/cardiac-rhythm-management/remote-monitoring.html
Boehmer, J. P., Hariharan, R., Devecchi, F. G., Smith, A. L., Molon, G., Capucci, A., ... & Thompson, J. A. (2017). A Multisensor Algorithm Predicts Heart Failure Events in Patients With Implanted Devices.
Boston Sceintific. (2019). LATITUDE™ NXT . https://www.bostonscientific.com/en-US/products/remote-patient-monitoring/latitude-nxt.html
Gardner, R. S., Singh, J. P., Stancak, B., Nair, D. G., Cao, M., Schulze, C., ... & Zhang, Y. (2018). HeartLogic multisensor algorithm identifies patients during periods of significantly increased risk of heart failure events: results from the MultiSENSE study. Circulation: Heart Failure , 11 (7), e004669.
Mittal, S., Piccini, J. P., Fischer, A., Snell, J., Dalal, N., & Varma, N. (2014). Increased adherence to remote monitoring is associated with reduced mortality in both pacemaker and defibrillator patients. Heart Rhythm , 35th.
Mittal, S., Piccini, J. P., Snell, J., Prillinger, J. B., Dalal, N., & Varma, N. (2016). Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation. Journal of Interventional Cardiac Electrophysiology , 46 (2), 129-136.
Saxon, L. A., Hayes, D. L., Gilliam, F. R., Heidenreich, P. A., Day, J., Seth, M., ... & Boehmer, J. P. (2010). Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: the ALTITUDE survival study. Circulation , 122 (23), 2359-2367.
