The informative contribution of the “virtual medical visit” in a new heart failure telemedicine integrated system

Introduction Telemedicine systems consist of collection, transmission and analysis of biometric data essentially based on instrumental measures. Our goal is to evaluate if information collected from patients have an incremental informative value in automatically rate the patient health status. Materials and Methods We present preliminary results of a new telemedicine system (ASCOLTA) obtained by observation of 12 heart failure patients (IIb-III NYHA). Instrumental data (EKG, O2 saturation level and respiration rate) were wireless daily collected together with clinical data (weight, heart rate, blood pressure values) and patients information through a web questionnaire, simulating a virtual medical visit. Health status was independently judged by two blinded cardiologists and by the patient’s cardiologist on the basis of 348 daily clinic reports. Random forest classification analysis was applied to 240 complete clinical report variables in order to estimate the judged health status. Results The results show that the use of “patients information” leads to a better predicting ability in comparison with the only physiological parameters assessed by instruments. The complete set of variables (Patient + Instrumental) achieve 84% of concordance, compared with 72% of the only instrumental variables and the 69% of patients variables. The ROC curves graphically confirm the described results. Discussion The patients have an active role in home monitoring and their information appears relevant for a new telemedicine approach integrating subjective and objective vital signs: only combining “patients information” with instrumental parameters it is possible to achieve a more correct automatic classification of health status of heart failure patients