Observed annually on September 29, World Heart Day comes as a reminder to prioritise heart health. The role healthcare businesses hold in improving heart health through quality metrics is an important one as it can directly help in reducing readmission rates for heart-related issues, improving patient satisfaction, and achieving better long-term outcomes.
Over the last three decades, cardiovascular quality indicators for inpatient care have evolved rapidly. Quality metrics in cardiovascular care are fundamentally intended to improve the quality of care provided to patients, hence improving patient outcomes such as mortality, hospital admission, and patient experience.
Cleveland Clinic’s Head of International Healthcare and Cardiologist Dr. Curtis Rimmerman and Mediclinic Parkview Hospital’s Consultant Family Medicine Dr. Mansour Anwar Habib share insights about the role of quality metrics in heart health and how wearables provide analysis support.
Measuring quality metrics specific to cardiovascular health
Dr. Rimmerman says that working with patients to develop a therapeutic plan and measure the relevant clinical results over the course of the patient's therapy establishes key performance indicators for common diagnoses and treatments that are delivered in a cardiovascular setting. “When I think of value-based care, I think of health outcomes per cost. It is about improving the efficiency of healthcare delivery and enhancing value. If we only focus on cost, outcomes may suffer, versus if only outcomes are prioritised the cost may go up. When we think about a patient’s adherence to their treatment plan, that is also where patient experience comes in. Managing patients through carefully conducted research and results, consensus guidelines, and then building performance indicators around those consensus guidelines, really drives outcomes,” he says.
Dr. Rimmerman emphasises that quality outcomes are important and patient experience also contributes to it. Patients today have a choice and can pick their provider, requesting available metrics for their diagnosis to make their decisions. Transparency of results in cost can give those patients peace of mind in knowing that they have chosen the best medical centre and begin their healthcare journey with upfront confidence.
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“At the Cleveland Clinic we perform carefully conducted clinical trials, which are typically randomised — not retrospective, but instead prospective. The clinical trials at our organisation and others establish guidelines for treatment. These guidelines form performance indicators or KPIs that are relevant to each specific diagnosis or treatment plan, following those performance indicators and forum performance, then feed into outcomes. We also factor in standard operating processes, and the efficiencies of care, perhaps reducing the number of vendors we work with for volume-based purchasing. This is to drive down the costs, shorten the length of stay, and reduce treatment complications, all of which will improve outcomes, and reduce cost,” he says.
Role of wearables in heart health quality metrics
Dr. Habib explains that different wearables have different algorithms and tools within them, to help monitor various aspects of the health parameters. “The Apple Watch for example when it comes to heart health has four interesting features. Number one, it captures if the heart rate goes above a certain limit that you set up in the device itself. The other aspect is if the heart rate goes below a certain threshold, and if it is consistent, it will also give an alert and that will nudge the patient.
“The third aspect is related to the irregularity of the heartbeat. Nowadays, people have different issues, one of them is related to the regularity and the rhythm of the heart, and one of the very common diseases that we can capture at an early stage is atrial fibrillation. This condition affects the part of the heart muscle wherein it beats in an uncontrollable way. If this occurs on a regular basis and is captured by the wearable, a notification goes out to the wearer, capturing it at the right time. The fourth aspect of heart health monitoring is the ECG or the EKG, it gives an indicator and insight if there any issue with the electricity of the heart,” he explains.
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Coming to quality metrics, Dr. Habib says important quality metrics pertain to the number of admissions, mortality rate and rise of complications. With technology’s support in the world of health, practitioners and patients can analyse an enhanced complication profile. For example, a case study in which a patient received frequent alerts of a high heart rate was due to blocked arteries. The alerts encouraged him to visit the hospital at the right time to receive the correct form of care to apply a stent and widen his blood pipes and arteries to avoid a more serious complication.
“In this case, the patient may have suffered a heart attack and would have been hospitalised. The cost from a resource perspective would be more along with complications and prolonged recovery time. This would impact the productivity of the patient in his workplace, social aspect, and personal life. From a quality perspective, the more we leverage wearables and technology, the better we will be able to mitigate the long-term impact of the cost of mortality and productivity. In instances of sudden heart attacks, patients lose their lives, with wearables if indicators can be captured at an early stage, we can enhance quality of the human lives,” concludes Dr. Habib.
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