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. 2017 Oct 2;5(10):e127.
doi: 10.2196/mhealth.7058.

Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study

Heesun Lee  1   2 , Jun-Bean Park  1   3 , Sae Won Choi  4 , Yeonyee E Yoon  1   5 , Hyo Eun Park  1   2 , Sang Eun Lee  6 , Seung-Pyo Lee  1   3 , Hyung-Kwan Kim  1   3 , Hyun-Jai Cho  1   3 , Su-Yeon Choi  1   2 , Hae-Young Lee  1   3 , Jonghyuk Choi  7 , Young-Joon Lee  7 , Yong-Jin Kim  1   3 , Goo-Yeong Cho  1   5 , Jinwook Choi  8 , Dae-Won Sohn  1   3
Affiliations

Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study

Heesun Lee et al. JMIR Mhealth Uhealth. .

Abstract

Background: Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF.

Objective: The objective of this study was to evaluate whether a new information communication technology (ICT)-based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients.

Methods: In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management.

Results: Among the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence.

Conclusions: Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program.

Keywords: compliance; heart failure; selfcare; telemedicine.

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Conflict of interest statement

Conflicts of Interest: Jong-Hyuk Choi and Young-Joon Lee hold a patent of invention for voice recognition technology applied to HF self-care management (Korea patent number 10-1141605). They are also employees and shareholders of AIMMED Co Ltd, which provides this ICT service. Other authors report no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study flow of ICT-based telehealth program in HF. ICT: information communication technology. HF: heart failure, LV: left ventricular, NYHA: New York Heart Association, TTE: transthoracic echocardiography, AMI: acute myocardial infarction, UA: unstable angina.
Figure 2
Figure 2
Schematic diagram of the ICT-based telehealth program in HF. ICT: information communication technology, HF: heart failure, TTS: text to speech, IVR: interactive voice response, PBX: private branch exchange, CTI: computer telephony integration, TCP: transmission control protocol, WAS: Web application server, REC: recording, IP: Internet Protocol.
Figure 3
Figure 3
An example of flow diagram for voice recognition program. The voice recognition component of the automatic call and response system enabled the recognition of the patient’s voice data to be input into the ICT-based telehealth program. Patients were requested to speak a pre-set range of inputs, such as body weight, blood pressure, heart rate, and heart failure-related symptoms. Patients were guided by a series of pre-specified verbal questions and examples of possible answers. To ensure the accuracy of the obtained data, the program allowed patients to either confirm or correct the initial extracted data.
Figure 4
Figure 4
Changes in major outcomes over time by ICT-based telehealth program in total study population. There was no significant changes in uNa (a), MLHFQ scores (b), 6-minute walk distance (c), and NT-proBNP level (d) after 12 weeks of ICT-based telehealth program. ICT: information communication technology, HF: heart failure, NT-proBNP: N-terminal prohormone of brain natriuretic peptide, MLHFQ: Minnesota Living with Heart Failure Questionnaire.
Figure 5
Figure 5
Changes in major outcomes over time by information communication technology (ICT)–based telehealth program in patients with good adherence. In patients with good adherence, uNa significantly decreased after 12 weeks of intervention (a), whereas MLHFQ scores marginally decreased (b). There were no changes in 6-minute walk distance (c) and NT-proBNP level (d). NT-proBNP: N-terminal prohormone of brain natriuretic peptide, MLHFQ: Minnesota Living with Heart Failure Questionnaire.
Figure 6
Figure 6
Changes in major outcomes over time by information communication technology (ICT)–based telehealth program in patients without good adherence. In patients without good adherence, no significant changes were observed in laboratory and functional outcomes after 12 weeks of ICT-based telehealth program (a-d). NT-proBNP: N-terminal prohormone of brain natriuretic peptide, MLHFQ: Minnesota Living with Heart Failure Questionnaire.
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