Flowing Forward: The Evolution of Remote Cardiac Monitoring in Belgium

Sep 28, 2023 - 10 min. read time

In this final instalment of this series, we will look at the following: The growth of our cardiology Flows in Belgium, some early data on the potential clinical impact of long-term monitoring using cardiology Flows, the evolution of cardiology Flows towards newer use cases, and the growth of cardiology Flows in Belgium.

Vinoy Vijayan
Medical Stakeholder Ambassador

Flowing Forward: The Evolution of Remote Cardiac Monitoring in Belgium

Sep 28, 2023 - 10 min.

In this final instalment of this series, we will look at the following: The growth of our cardiology Flows in Belgium, some early data on the potential clinical impact of long-term monitoring using cardiology Flows, the evolution of cardiology Flows towards newer use cases, and the growth of cardiology Flows in Belgium.

Reach out to our experts

Flowing Forward: The Evolution of Remote Cardiac Monitoring in Belgium

Sep 28, 2023 - 10 min.

In this final instalment of this series, we will look at the following: The growth of our cardiology Flows in Belgium, some early data on the potential clinical impact of long-term monitoring using cardiology Flows, the evolution of cardiology Flows towards newer use cases, and the growth of cardiology Flows in Belgium.

Reach out to our experts

This is part three of a three-part series on the role of remote patient monitoring in the post-stroke pathway.

In part one, we discussed how continuous cardiac monitoring with wearables benefits cryptogenic stroke patients by detecting heart rhythm issues like atrial fibrillation early, reducing stroke risk. We highlighted limitations of current short-term monitoring methods such as Holter monitors, proposing that new wearable tools address these issues, align with guidelines, and improve treatment.

In part two, we introduced our “Flows” for cardiology, like Afib Flow, offering long-term home monitoring via a wearable patch and cloud platform. We touched on service aspects like our pay-per-use model, which provides cost savings and flexibility for hospitals.

We ended by promising real-world data on adoption of our cardiology solutions, demonstrating their alignment with the shift towards value-based healthcare.

In this final instalment of this series, we will look at the following:

  1. The growth of our cardiology Flows in Belgium
  2. Examine some early data on the potential clinical impact of long-term monitoring using cardiology Flows
  3. The evolution of cardiology Flows towards newer use cases.

The growth of our cardiology Flows in Belgium

Our cardiology Flows have seen swift uptake since their rollout in Belgium in January 2022. What started with Afib Flow as an alternative long-term at-home cardiac monitoring option for cryptogenic stroke patients, has since expanded into versatile services used across indications. In the last 18 months, over 30 hospitals and clinics have used one of our Flows.

Some key statistics include:

  • >300,000 hours of patient data recorded: Demonstrating the extensive use and reliability of our cardiology Flows.
  • >28,000 annotations made on the data: Highlighting the wealth of information available for clinicians.
  • Median monitoring time of 13 (+/- 11) days: A flexible approach that caters to individual patient needs.
  • Longest monitoring period of 64 days: Showcasing the adaptability of the system.

Our Flows offer healthcare professionals unmatched flexibility in cardiac monitoring. Unlike solutions with rigid 7 or 14 day monitoring periods, they allow providers to customize monitoring to each patient’s unique needs. Patients can be monitored for 30 days or even for 1 day, as we discuss later in this article.

An analysis of Flow utilization revealed the full spectrum of monitoring durations, from 1 to over 30 days. The graph below illustrates the percentage of patients monitored by number of days:

Percentage of patients per monitoring duration

Key findings from the data:

  • Two preferred long-term monitoring periods emerged — approximately 14 and 30 days. This suggests certain hospitals find 2 weeks ideal for their patient population, while others benefit from month-long monitoring.
  • Many patients fell between these periods, likely because monitoring was stopped once sufficient data and annotations were obtained.

This ability to tailor monitoring periods to the patient and care scenario is a key advantage of our Flows. The flexibility empowers providers to make data-driven decisions on monitoring length for optimal diagnostic insights and patient care.

As the data shows, our Flows are successfully used for both short-term and long-term continuous cardiac monitoring.

Many patients were monitored by a Flow for one day only. These were not post-stroke patients, but a new use case that has evolved over the course of our services’ adoption in Belgium.

We will touch on this later when we explore how our 24h Flow has been effectively implemented for short-term monitoring across hospitals in Belgium, highlighting an innovative new application of the technology.

Atrial Fibrillation Detection with Extended Monitoring

Continuous cardiac monitoring promises increased detection of potential atrial fibrillation (AF) compared to short or in-hospital monitoring. International guidelines recommend prolonged monitoring after cryptogenic stroke, so we examined AF detection rates using our Afib Flow[1].

We analysed two cohorts: those monitored for 0–2 weeks and those observed for 2–5 weeks, each comprising roughly 400 patients.

For each monitoring day (e.g. day 10), we assessed patients who had been monitored for that duration and calculated the percentage who had at least one potential AF event annotated.

The results paint a compelling picture: AF detection increased steadily with longer monitoring in both groups, aligning with published research. By day 10, a striking 15–25% of patients had potential AF.

Percentage of patients with annotated atrial Fibrillation

Our ~25% detection at 10 days and ~30% by 30 days compares favourably when compared to similar studies. A pooled analysis of published single arm studies demonstrated that the rate of detected AF increases with the duration of monitoring, from about 8.9% at 1 month to 17.9% at 6 months, 22.3% at 12 months and 25.2% at 36 months[2].

Hence, our detection rates are on par with the performance of implantable loop recorders monitoring for durations ranging from twelve to thirty-six months with a much more user-friendly and cheaper solution.

AF detection plateaued in both cohorts, but at different times — around day 10 for 0–2 weeks and day 25 for 2–5 weeks. This suggests differing cohort characteristics, which may explain their personalized monitoring durations. The plateau within each period indicates patients were appropriately chosen, as detection maximized within the monitoring time frame.

In summary, our real-world data corroborates published studies showing prolonged monitoring improves AF detection. Our detection rates aligned with or exceeded literature benchmarks. Tailoring monitoring duration to patient profile allowed efficient AF detection within the prescribed period.

3. Evolution of Flows towards new use cases

After much positive feedback from clinicians, we expanded our services beyond Afib Flow. We developed a new 1-day monitoring service called 24h Flow as an alternative to Holter monitoring. This service aims to address long waiting times for Holters and enable quicker diagnosis.

Because our services don’t require devices to be purchased, 24h Flow is accessible to smaller practices, not just large hospitals. Patients are set up with our monitoring device before discharge. After wearing it for 24 hours at home, they simply mail it back. This eliminates an extra hospital visit. It also provides physicians faster access to results and insights.

The huge adoption of our 24h Flow service over the past few months. In this graph, we depict the weekly distribution of patients initiated on cardiology Flows. We have represented the percentage of patients during a specific week, relative to the total number of patients.

As can be seen in the graph above, our 24h Flow has seen exponential growth, now representing the majority of our cardiology use cases.

The service has also benefited from the existing reimbursement codes. This is in contrast with the long-term monitoring service, which does not have reimbursement in Belgium. Given this successful adoption, we plan to expand availability of the 24h Flow to benefit more patients and healthcare providers.

In summary, the 24h Flow offers a convenient and cost-effective ambulatory cardiac monitoring solution. By facilitating faster diagnosis, it can improve a care team’s workflow efficiency, enabling better patient outcomes. We look forward to bringing these benefits to more practices and patients.

The Road Ahead

We are integrating with the Belgian eHealth landscape to allow different hospitals systems to easily access and use our cardiology Flows.

All providers involved in a patient’s care can securely access cardiac data remotely via an online dashboard. This can enable streamlined collaboration across providers within a care path.

By transitioning monitoring to an at home setting and a pay-per use model, Flows can help reduce hospital and healthcare costs.

Securing reimbursement is a critical step towards achieving widespread adoption and integration of digital health solutions into established protocols.

To accomplish this, it is crucial that government bodies and healthcare providers overseeing reimbursement policies exhibit a willingness to revolutionize the current payment landscape. Simply crafting new billing codes with larger sums to make extended monitoring financially advantageous isn’t enough. Such an approach merely adds to the existing fee-for-service model, which is increasingly viewed as less desirable than models that also give importance to value and outcomes.

We assert unequivocally: Digital solutions like our Flows not only rise to this challenge but also provide a model for organizing healthcare around the patient’s needs with a focus on value-based care.

Conclusions

Our Flows offer many advantages including enhanced detection of atrial fibrillation in stroke patients through extended, flexible on-demand monitoring that allows providers to start or stop as needed for personalized care, and adaptability to new use cases like a 24-hour Holter alternative.

In summary, Byteflies cardiology Flows provides proactive, patient-centered cardiac care by tailoring monitoring to individual needs. The service demonstrates how intelligent remote monitoring can revolutionize healthcare delivery through enhanced efficiency, affordability, accessibility, and provide timely data to inform treatment decisions.

Learn how our Flows can empower your team.

The information contained in this article represents the views and opinions of the writer(s) and does not necessarily represent the views or opinions of other parties referenced or mentioned therein.

The article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you read in this article.

Subscribe to our newsletter and follow our journey:

Request sample patient reports:

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Patient demo report

This is part three of a three-part series on the role of remote patient monitoring in the post-stroke pathway.

In part one, we discussed how continuous cardiac monitoring with wearables benefits cryptogenic stroke patients by detecting heart rhythm issues like atrial fibrillation early, reducing stroke risk. We highlighted limitations of current short-term monitoring methods such as Holter monitors, proposing that new wearable tools address these issues, align with guidelines, and improve treatment.

In part two, we introduced our “Flows” for cardiology, like Afib Flow, offering long-term home monitoring via a wearable patch and cloud platform. We touched on service aspects like our pay-per-use model, which provides cost savings and flexibility for hospitals.

We ended by promising real-world data on adoption of our cardiology solutions, demonstrating their alignment with the shift towards value-based healthcare.

In this final instalment of this series, we will look at the following:

  1. The growth of our cardiology Flows in Belgium
  2. Examine some early data on the potential clinical impact of long-term monitoring using cardiology Flows
  3. The evolution of cardiology Flows towards newer use cases.

The growth of our cardiology Flows in Belgium

Our cardiology Flows have seen swift uptake since their rollout in Belgium in January 2022. What started with Afib Flow as an alternative long-term at-home cardiac monitoring option for cryptogenic stroke patients, has since expanded into versatile services used across indications. In the last 18 months, over 30 hospitals and clinics have used one of our Flows.

Some key statistics include:

  • >300,000 hours of patient data recorded: Demonstrating the extensive use and reliability of our cardiology Flows.
  • >28,000 annotations made on the data: Highlighting the wealth of information available for clinicians.
  • Median monitoring time of 13 (+/- 11) days: A flexible approach that caters to individual patient needs.
  • Longest monitoring period of 64 days: Showcasing the adaptability of the system.

Our Flows offer healthcare professionals unmatched flexibility in cardiac monitoring. Unlike solutions with rigid 7 or 14 day monitoring periods, they allow providers to customize monitoring to each patient’s unique needs. Patients can be monitored for 30 days or even for 1 day, as we discuss later in this article.

An analysis of Flow utilization revealed the full spectrum of monitoring durations, from 1 to over 30 days. The graph below illustrates the percentage of patients monitored by number of days:

Percentage of patients per monitoring duration

Key findings from the data:

  • Two preferred long-term monitoring periods emerged — approximately 14 and 30 days. This suggests certain hospitals find 2 weeks ideal for their patient population, while others benefit from month-long monitoring.
  • Many patients fell between these periods, likely because monitoring was stopped once sufficient data and annotations were obtained.

This ability to tailor monitoring periods to the patient and care scenario is a key advantage of our Flows. The flexibility empowers providers to make data-driven decisions on monitoring length for optimal diagnostic insights and patient care.

As the data shows, our Flows are successfully used for both short-term and long-term continuous cardiac monitoring.

Many patients were monitored by a Flow for one day only. These were not post-stroke patients, but a new use case that has evolved over the course of our services’ adoption in Belgium.

We will touch on this later when we explore how our 24h Flow has been effectively implemented for short-term monitoring across hospitals in Belgium, highlighting an innovative new application of the technology.

Atrial Fibrillation Detection with Extended Monitoring

Continuous cardiac monitoring promises increased detection of potential atrial fibrillation (AF) compared to short or in-hospital monitoring. International guidelines recommend prolonged monitoring after cryptogenic stroke, so we examined AF detection rates using our Afib Flow[1].

We analysed two cohorts: those monitored for 0–2 weeks and those observed for 2–5 weeks, each comprising roughly 400 patients.

For each monitoring day (e.g. day 10), we assessed patients who had been monitored for that duration and calculated the percentage who had at least one potential AF event annotated.

The results paint a compelling picture: AF detection increased steadily with longer monitoring in both groups, aligning with published research. By day 10, a striking 15–25% of patients had potential AF.

Percentage of patients with annotated atrial Fibrillation

Our ~25% detection at 10 days and ~30% by 30 days compares favourably when compared to similar studies. A pooled analysis of published single arm studies demonstrated that the rate of detected AF increases with the duration of monitoring, from about 8.9% at 1 month to 17.9% at 6 months, 22.3% at 12 months and 25.2% at 36 months[2].

Hence, our detection rates are on par with the performance of implantable loop recorders monitoring for durations ranging from twelve to thirty-six months with a much more user-friendly and cheaper solution.

AF detection plateaued in both cohorts, but at different times — around day 10 for 0–2 weeks and day 25 for 2–5 weeks. This suggests differing cohort characteristics, which may explain their personalized monitoring durations. The plateau within each period indicates patients were appropriately chosen, as detection maximized within the monitoring time frame.

In summary, our real-world data corroborates published studies showing prolonged monitoring improves AF detection. Our detection rates aligned with or exceeded literature benchmarks. Tailoring monitoring duration to patient profile allowed efficient AF detection within the prescribed period.

3. Evolution of Flows towards new use cases

After much positive feedback from clinicians, we expanded our services beyond Afib Flow. We developed a new 1-day monitoring service called 24h Flow as an alternative to Holter monitoring. This service aims to address long waiting times for Holters and enable quicker diagnosis.

Because our services don’t require devices to be purchased, 24h Flow is accessible to smaller practices, not just large hospitals. Patients are set up with our monitoring device before discharge. After wearing it for 24 hours at home, they simply mail it back. This eliminates an extra hospital visit. It also provides physicians faster access to results and insights.

The huge adoption of our 24h Flow service over the past few months. In this graph, we depict the weekly distribution of patients initiated on cardiology Flows. We have represented the percentage of patients during a specific week, relative to the total number of patients.

As can be seen in the graph above, our 24h Flow has seen exponential growth, now representing the majority of our cardiology use cases.

The service has also benefited from the existing reimbursement codes. This is in contrast with the long-term monitoring service, which does not have reimbursement in Belgium. Given this successful adoption, we plan to expand availability of the 24h Flow to benefit more patients and healthcare providers.

In summary, the 24h Flow offers a convenient and cost-effective ambulatory cardiac monitoring solution. By facilitating faster diagnosis, it can improve a care team’s workflow efficiency, enabling better patient outcomes. We look forward to bringing these benefits to more practices and patients.

The Road Ahead

We are integrating with the Belgian eHealth landscape to allow different hospitals systems to easily access and use our cardiology Flows.

All providers involved in a patient’s care can securely access cardiac data remotely via an online dashboard. This can enable streamlined collaboration across providers within a care path.

By transitioning monitoring to an at home setting and a pay-per use model, Flows can help reduce hospital and healthcare costs.

Securing reimbursement is a critical step towards achieving widespread adoption and integration of digital health solutions into established protocols.

To accomplish this, it is crucial that government bodies and healthcare providers overseeing reimbursement policies exhibit a willingness to revolutionize the current payment landscape. Simply crafting new billing codes with larger sums to make extended monitoring financially advantageous isn’t enough. Such an approach merely adds to the existing fee-for-service model, which is increasingly viewed as less desirable than models that also give importance to value and outcomes.

We assert unequivocally: Digital solutions like our Flows not only rise to this challenge but also provide a model for organizing healthcare around the patient’s needs with a focus on value-based care.

Conclusions

Our Flows offer many advantages including enhanced detection of atrial fibrillation in stroke patients through extended, flexible on-demand monitoring that allows providers to start or stop as needed for personalized care, and adaptability to new use cases like a 24-hour Holter alternative.

In summary, Byteflies cardiology Flows provides proactive, patient-centered cardiac care by tailoring monitoring to individual needs. The service demonstrates how intelligent remote monitoring can revolutionize healthcare delivery through enhanced efficiency, affordability, accessibility, and provide timely data to inform treatment decisions.

Learn how our Flows can empower your team.

The information contained in this article represents the views and opinions of the writer(s) and does not necessarily represent the views or opinions of other parties referenced or mentioned therein.

The article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you read in this article.

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