Amsterdam Telemonitoring And Hypertension Initiative

In the Netherlands 30% of the adult population is hypertensive. Many of these patients are still untreated or uncontrolled despite blood pressure medication, leading to considerable morbidity and associated high health care costs. Self-management of hypertension combined with telehealth monitoring and behaviour modification has been proven to improve hypertension control. This public private partnership between Amsterdam UMC location AMC, AHTI (Amsterdam Health and Technology Institute) and Heart for Health ICT (Part of Cardiologie Centra Nederland) brings together 3 healthcare partners that will develop a novel self-management tool with an automated and intelligent patient triaging and treatment system for the management of hypertension. After this research project, treatment of hypertensive patients can be personalized based on the results of self-measurements in combination with smart algorithms. Through this  approach we expect that significantly more people will have controlled hypertension with equal or lower healthcare costs because we expect that the personalized care will improve adherence and decreases the number of practice visits. Currently, an algorithm has been developed that automatically generates a cardiovascular risk estimation and a treatment advice based on recent national guidelines and on input provided by both patient and doctor. Testing of this tool by the researchers and 5 general practitioners showed that the computerized algorithm generated a cardiovascular risk estimation and treatment advice that can be safely applied in a patient population with different cardiovascular risk. Now the team is working on the usability and integration of the tool in the information systems of the GP’s. Next, we will investigate whether historical data can be used for the development of a working machine learning process that is able to provide input on treatment decisions and patient adherence.   

Conclusions 

• It is possible to develop an automated triage and treatment allocation system, however, to live up to its potential three challenges must be addressed: 1) full integration with existing information systems, including exchange of medical data, 2) optimizing user interface to minimize user effort and 3) GPs views and opinions about automated treatment advice.  

• Patients are willing to measure their blood pressure at home. 

• Measuring blood pressure at home increases the chance of achieving blood pressure control in hypertensive patients. 

Preliminary results of qualitative research showed that patients have positive views and experiences towards the home measurement of blood pressure using the mobile application. Quantitative research shows that in a group of hypertensive patients using home blood pressure measurement, the number of patients getting their blood pressure under control increased by 49%, compared to 18% in the group not using home measurement. 

The hypertension service resulting from the ATHENA project, was further developed in the DHoTS project. After the project, it is being used in 16 GP practices (>20 GP’s) and over 500 patients have measured their blood pressure at home making use of the mobile application, resulting in approximately 10.500 measurements. The service is validated and the aim is that, as from January 1, 2022 GP’s are paying for the service. Private partner H4H/CCN has the intention to continue the DHoTS service as one of their products.