Knowing the numbers

Digital health technologies are transforming the way hypertension is managed says Kaushik Gune, Head

While surfing the web recently, I paused when I came across a consumer review of the best blood pressure monitors for home use. Not because I’m looking for a new one, but because this article is at least the sixth such comparison I’ve seen in the press in the past couple of months. As Head of US Healthcare at Huma, a leading global digital health company, I’m relieved to know that people want to ‘know their numbers’

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US Healthcare at Huma because undiagnosed and uncontrolled hypertension, or high blood pressure, puts us at greater risk of cardiovascular events such as stroke, heart attack, atrial fibrillation, renal dysfunction, and other disorders.

120 over 80 is a big numbers game. Hypertension a ects a staggering 1.28 billion people globally. In 2020 more than 670,000 deaths in the United States had hypertension as the primary or contributing cause. According to the

US Centers for Disease Control and Prevention, nearly 1 out of 2 adults— around 108m —have high blood pressure, and only 1 in 4 have their condition under control. It’s costing the nation up to $198 billion annually in healthcare services, medications, and loss of productivity from premature death. Fortunately, high blood pressure is treatable, and thanks to the rapid growth of digital technologies, we have a real chance at getting a handle on our systolic and diastolic numbers.

Previously, it would have been usual for clinicians to make 2 or 3 attempts at measuring blood pressure during an appointment. Reading anomalies might occur due to classic white coat syndrome, or because things weren’t going well at home, or simply because of the time of day. Now, we understand that having more data points in the home and ambulatory setting can unmask a person’s true blood pressure, allowing for better control through medication and behavior changes. Worldwide guidelines recommend treating hypertension based on 24-hour ambulatory blood pressure monitoring and home blood pressure measurements, rather than one-o recordings in a doctor’s o ice.

Measuring pressure at a distance

Huma’s digital platform is readily configurable to support the remote monitoring of hypertension. It is device

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agnostic, so a range of blood pressure cu s and sensors are able to be used, and it has around 150 modular components to choose from to build a bespoke programme. This flexibility allows clinicians to create the hypertension virtual clinic that meets their needs versus being forced to use a one-size-fits-all solution. For example, they can choose from a variety of questionnaires to capture an holistic picture of the patient through selfreported readings and symptoms which can be read on a customisable dashboard.

Healthcare providers can buy the monitoring module alone and manage the portal themselves, or as many prefer, Huma can provide a clinicallyqualified team to monitor data from patients on their behalf. The monitoring team operates under the general supervision of the healthcare provider according to a red, amber, green referral system: depending on the pre-agreed parameters, red usually triggers a clinical notification right away; amber may mean the doctor’s o ice can decide; two consecutive ambers can equal a red and so on. And rather than setting the same thresholds for everyone, Huma’s so ware accommodates individual patients, meaning that the monitoring team will only escalate to clinicians depending on each person’s profile.

While the monitoring team gathers additional readings and data and presents this to the provider, they don’t currently triage patients in terms of making medical decisions. This may change in the future. Last month, Huma became the first company in the world to gain EU-MDR Class IIb regulatory status for our disease-agnostic So ware as Medical Device. This level of certification means that, in Europe and the United Kingdom, our platform is now able to host machine learning algorithms that support risk prediction and diagnosis, and is permitted to aid clinicians in managing serious and critical health conditions. In other words, ClassIIb approval turns data reporting into data insight, reducing the burden on HCPs by delivering proactive care through advanced triage alerts, filters and flags.

Value-based digital care

Remote patient monitoring allows the e ects of therapeutic interventions to be assessed in real time rather than waiting weeks until another in-person visit. Antihypertensive medicines act quickly, o en within hours, to bring about blood pressure lowering, and automated recording with associated data on how the patient is feeling and their general health is very valuable. Plus, a patient doesn’t make recording errors, or forget to bring their logbook. Automated readings o er better, real world control.

Sometimes patients do not fully understand their condition. Huma’s platform therefore also contains educational materials to help coach patients with hypertension to make lifestyle changes, such as improving their diet and exercise habits, quitting smoking, and reducing stress levels to empower patients.

Our monitoring team also supports clinics in the billing codes for remote patient monitoring programmes by providing a comprehensive report with details of clinical support, connected device data, and patient utilisation.

As healthcare turns increasingly towards value-based care to answer many of the issues caused by a focus on feefor-service, Huma is well-positioned to partner with forward-thinking healthcare leaders in providing e ective, low-cost, outcome-based care. Value-based payment models are moving mindsets towards upstream disease management and the holistic insights that come from remote patient monitoring to support quality initiatives and revenue drivers within this new system. We estimate that annual medical costs for patients with high blood pressure are up to $2,500 higher than those for patients without hypertension. We have to help turn the tide: in the US, approximately 90 per cent of all health expenses go to disease and injury treatment rather than to addressing the predisposing factors of these illnesses and injuries.

Broad reach into cardiovascular disease

Huma’s platform is disease agnostic and hypertension is only one of the cardiovascular disease (CVD) conditions for which it can help people live longer, fuller lives. Together with Bayer, we currently have a campaign running across the US encouraging people to take a brief web or app based assessment which is underpinned by our peer-reviewed algorithm that accurately estimates an individual’s CVD risk over the next decade. As with blood pressure measurements, these types of risk assessment tools were historically designed to be applied in the doctor’s o ice.

The Bayer campaign aims to reach more than 100m people who may be at risk of CVD across the US with actionable insights to help improve their heart and overall health; all that is needed is access to a digital device. Through digital excellence, our goal is to empower everyone, regardless of where they live, their background or socioeconomic status, to be able to assess their individual risk of CVD and initiate a conversation with a healthcare professional where necessary. Working with researchers from Stanford University School of Medicine, our Decentralized Trial in Atrial fibrillation Patients study was one of the first peerreviewed assessments to examine whether a clinical trial operated remotely, away from a clinical centre, would be feasible and e ective for patients with a heart condition. The study, known as DeTAP and published last year saw rapid recruitment (94 per cent of patients signed up for the study in just 12 days), high engagement, and patients who otherwise failed to comply with their treatment regime showed an increased adherence to medication when linked remotely through our digital interface to their clinicians.

When it comes to heart failure, there are plenty of novel therapies available but identification of the patients who benefit from these treatments remains a challenge. Working with two health boards in the UK to conduct pilot studies in heart failure patients discharged from hospital, we successfully demonstrated that remote monitoring of patients can facilitate significant reductions in treatment optimisation times by helping upgrade patients to newer, highly-e ective medical therapies much earlier in a guidelinedirected manner.

I’m immensely proud of the positive contribution to healthcare across all disease areas that our digital platform is making. And given that most chronic disease management occurs outside of the traditional health care setting, I’m optimistic that as digital technology becomes part of mainstream healthcare, we will achieve better health outcomes for all and reduce health care spending. The future of health is digital.