Heart failure is one of the fastest growing cardiovascular conditions in the world that places significant strain on patients, families, and healthcare systems worldwide. It is a chronic condition caused by the heart not functioning properly or having structural issues¹, often accompanied by other serious chronic diseases such as diabetes, hypertension, atrial fibrillation, kidney problems, and chronic obstructive pulmonary disease.

Patients experience a wide range of symptoms, including unexpected weight gain, swelling of lower extremities, fatigue, shortness of breath, loss of energy, or extreme fatigue. Additionally, many experience depression, anxiety, and reduced quality of life. The emotional weight of heart failure impacts both patients and caregivers, who must manage medication, appointments, and frequent trips to the emergency room.²

In Canada, there are currently over 750,000 people living with heart failure, with an additional 100,000 new diagnoses each year. Heart failure is one of the top reasons for hospitalization across the country, and by 2030, associated healthcare costs are expected to reach $2.8 billion per year.3 While early diagnosis, lifestyle changes, innovative medicines, and medical devices can make a big impact, more tools are needed to help patients manage and track their symptoms to avoid a visit at the emergency room or a hospitalization.

CONTINUUM is a remote patient monitoring and digital therapeutics program working to help heart failure outpatients improve their overall wellbeing and reduce the number of emergency room visits and/or hospitalizations. The technology was recently piloted at the Centre Hospitalier de l’Université de Montréal (CHUM).

In a three-month pre-post pilot study for heart failure outpatients at risk of hospitalization, the CONTINUUM program was evaluated against the standard of care alone.

The CONTINUUM program includes:

• a smartphone/tablet application that patients use to enter vital signs, weight, and symptoms and then their data is monitored by clinical nurses from their home,
• heart failure education modules tailored to each patient relating to their condition and keeping them informed of treatment practices, lifestyle suggestions or other pertinent information,
• a dashboard for healthcare professionals that displays alerts,
• a digital therapeutics module that aids the medical team by providing suggestions to optimize care based on guideline-based treatment algorithms.

Preliminary results, presented at the American Heart Association Conference in 2023, demonstrated when patients use this application there is a direct link to significant reduction in emergency room visits and/or hospitalizations among the intervention group.⁴ Moreover, the total cost of healthcare consumption in the intervention group was $134,088 CAD, twenty-three per cent less than the $174,924 CAD in the control group.³

The success of the program is the result of a collaborative effort between the CHUM, the CHUM Research Centre, MEDTEQ+, Greybox Solutions Inc., and Boehringer Ingelheim (Canada) Ltd./ Ltée. With healthcare budgets and hospital staff under increased strain, this public-private partnership supported and helped fund this innovative healthcare solution. The program was recently awarded the MEDTEQ+ RSI prize by the Québec government at the ADRIQ innovation gala in recognition of its ability to transform health outcomes.

CONTINUUM is looking to expand throughout Québec and reach patients of other chronic diseases. It is my hope we see CONTINUUM and other innovative solutions stretch across the country to enable more medical professionals the ability to offer new possibilities to our heart failure patients.

By Dr. François Bernard Tournoux

Dr. François Bernard Tournoux, Cardiologist at the CHUM, Associate Professor, University of Montréal, FRQS Clinical Researcher at the CHUM Research Centre and principal investigator of the CONTINUUM trial.

^{1, 2, 3} Heart and Stroke Foundation. Heart failure in Canada: complex, incurable and on the rise. Available at:  https://www.heartandstroke.ca/what-we-do/media-centre/news-releases/heart-failure-in-canada-complex-incurable-and-on-the-rise

⁴ AHA Journals. Abstract 12585: The Impact of Remote Patient Monitoring and Digital Therapeutics on Major Clinical Events and Costs in Heart Failure Patients: Early Experience in the Quebec Public Healthcare System. Available at:  https://www.ahajournals.org/doi/10.1161/circ.148.suppl_1.12585