According to the World Health Organisation, cardiovascular disease remains the leading cause of death worldwide, responsible for around 17.9 million deaths a year. Its high prevalence is associated with unhealthy lifestyles characterised by poor diet, sedentary lifestyles, alcohol consumption, smoking and chronic stress, factors that contribute to persistent inflammatory processes and changes in the structure and function of blood vessels. These vascular alterations favour the formation of fatty plaques (atherosclerosis) which progressively obstruct blood flow, leading to various cardiovascular diseases. Cardiac Surgery
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DIGITAL TECHNOLOGY REVOLUTIONISING POST-CARDIAC SURGERY
Publication type: Article Summary
Original title: Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery
Article publication date: May 2022
Source: BMC Health Services Research
Authors: Ana Londral, Salomé Azevedo, Pedro Dias, Carolina Ramos, Jorge Santos, Flávio Martins, Raquel Silva, Helena Semedo, Clara Vital, Ana Gualdino, João Falcão, Luís Velez Lapão, Pedro Coelho & José Fragata
What is the goal, target audience, and areas of digital health it addresses?
The study aims to develop and validate a digital post-operative monitoring system for patients undergoing cardiac surgery, based on a remote telemonitoring system. The target audience includes healthcare professionals, such as surgeons and nurses specialising in cardiac surgery, as well as information technology teams and suppliers of Internet of Things (IoT) devices. The study falls into areas of digital health such as remote patient monitoring, the design of user-centred digital solutions and m-Health.
What is the context?
According to the World Health Organisation, cardiovascular disease remains the leading cause of death worldwide, responsible for around 17.9 million deaths a year. Its high prevalence is associated with unhealthy lifestyles characterised by poor diet, sedentary lifestyles, alcohol consumption, smoking and chronic stress, factors that contribute to persistent inflammatory processes and changes in the structure and function of blood vessels.
These vascular alterations favour the formation of fatty plaques (atherosclerosis) which progressively obstruct blood flow, leading to various cardiovascular diseases. These include high blood pressure, arrhythmias, coronary heart disease (obstruction of the arteries that supply the heart muscle), heart failure (impairment of the heart’s contractile function to pump blood effectively). Without early detection and intervention, these conditions can develop into serious acute events such as acute myocardial infarction, cerebrovascular accident (CVA) or even multiple organ failure due to insufficient circulation of blood and oxygen.
When the pharmacological approach is not sufficient, surgical intervention becomes necessary to restore cardiovascular function. However, despite their clinical efficacy, these interventions carry risks in the post-operative period, including arrhythmias, infections, thromboembolic events (formation of blood clots) and haemodynamic instability (persistently abnormal blood pressure). Hospital readmission rates range from 15% to 20% in the first month, and up to 30% over the first year after surgery.
What are the current approaches?
Currently, post-operative monitoring in cardiac surgery begins in a hospital environment, with intensive monitoring by doctors and nurses. Vital parameters such as heart rate, blood pressure, respiratory function, oxygenation, temperature, urine output and water balance are assessed, which are essential for early detection of complications and for guiding immediate clinical interventions. After hospital discharge, patients are integrated into cardiac rehabilitation programmes that combine the control of cardiovascular risk factors (hypertension, diabetes, obesity and sedentary lifestyle), the adjustment of pharmacological therapy according to clinical evolution, supervised exercise and educational support. The latter promotes health literacy, reinforces adherence to treatment and offers emotional support during the recovery process.
In recent years, remote monitoring solutions have emerged, mainly applied to chronic heart disease and to remote rehabilitation programmes. These approaches are based on the collection of physiological data via wearables and mobile applications, allowing patients to be monitored after returning home. However, they were not designed for the immediate post-operative period, characterised by greater clinical instability and the need for intensive monitoring. In addition, many have interfaces that are poorly adapted to patients in the recovery phase, lack structured mechanisms for real-time clinical response and are not integrated into hospital clinical flows, which makes it difficult for multidisciplinary teams to use them and jeopardises the continuity and effectiveness of follow-up.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consisted of the development of a structured digital system for the remote monitoring of post-cardiac surgery patients, with continuous home monitoring, coordination with the healthcare team and functionalities centred on the recovering person.
The development process followed the Design Science Research methodology, which favors the phased creation of solutions with continuous validation in real contexts. In parallel, the principles of Lean Startup were applied, which are based on the use of resources already available and rapid improvement based on feedback. In this case, the existing Digital Health Kits were used as a starting point for the development of the minimum viable product. Each kit included a smartphone with a 4G connection, ensuring continuous connectivity, a smartwatch for heart rate monitoring and step counting, a sphygmomanometer for measuring blood pressure and resting heart rate and a digital scale for monitoring body weight. All the IoT devices, were interconnected with the SMARTBEAT mobile application, developed as part of the project.
The app automatically collected the patient’s physiological data, while the patient submitted daily photographs of the surgical wound through a guided chatbot. In response, the patient received personalized educational messages, pre-defined, with the aim of strengthening health literacy throughout recovery. In addition, health professionals could send additional messages tailored to the clinical status of each patient.
A web platform was also developed for healthcare professionals, enabling real-time access to submitted data, management of clinical alerts, recording of interventions and structured monitoring of clinical progress. Although it doesn’t replace face-to-face contact, it provides complementary support for surveillance, facilitating the prioritisation of cases and supporting more informed clinical decision-making.
To assess the impact of this system, a pilot study was carried out at the Santa Marta Hospital in Lisbon, involving 30 patients undergoing cardiac surgery. Each patient was remotely monitored for 30 days, but the study was conducted over a period of 16 months, as improvements were introduced between monitoring cycles. The evaluation was organised into four successive cycles of development, testing and adaptation, allowing for continuous evolution of the solution according to the clinical context and user feedback. The analysis considered five main dimensions: (1) user experience, measured using the Net Promoter Score, the User Experience Questionnaire and face-to-face interviews; (2) adherence, assessed based on the regularity of data reporting throughout the monitoring period; (3) clinical feasibility, measured by the actual use of the platform by healthcare teams and the type of interventions recorded; (4) clinical effectiveness, assessed by comparing the incidence of critical events (such as hospital readmissions, re-interventions and mortality) between the monitored group and a historical control group; and (5) technical robustness, monitored through occurrences related to device or digital infrastructure failures.
What are the main results? What is the future of this approach?
The results of this study showed that the system developed was largely successful. Patient satisfaction with the experience was 88%. Adherence to daily monitoring was also high, with an average of 91.6 per cent of days with data reporting. In terms of clinical effectiveness, there was a statistically significant reduction in the occurrence of critical events, namely hospital readmissions, in the group of monitored patients compared to a historical control group (p=0.01). The system also proved highly feasible for integration into clinical practice, with 25 nurses and 2 surgeons actively participating in the use of the digital platform. Technical robustness was validated by the low incidence of failures in the IoT devices used. The functionality of sending personalised educational messages via chatbot was highly valued by patients, contributing to strengthening health literacy and an increased sense of security during the recovery process.
A randomised clinical trial with around 300 patients is planned, with the aim of more robustly validating the benefits observed, as well as identifying subgroups that could benefit more significantly from telemonitoring. At the same time, the application of predictive models based on machine learning is being developed, using the data collected to anticipate adverse events and support personalised clinical decisions. The methodology and technological infrastructure created are also considered replicable for other clinical contexts, particularly in highly complex surgical areas.
Would you like to know all the details?
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Home / Publications / Publication
DIGITAL TECHNOLOGY REVOLUTIONISING POST-CARDIAC SURGERY
Publication type: Article Summary
Original title: Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery
Article publication date: May 2022
Source: BMC Health Services Research
Authors: Ana Londral, Salomé Azevedo, Pedro Dias, Carolina Ramos, Jorge Santos, Flávio Martins, Raquel Silva, Helena Semedo, Clara Vital, Ana Gualdino, João Falcão, Luís Velez Lapão, Pedro Coelho & José Fragata
What is the goal, target audience, and areas of digital health it addresses?
The study aims to develop and validate a digital post-operative monitoring system for patients undergoing cardiac surgery, based on a remote telemonitoring system. The target audience includes healthcare professionals, such as surgeons and nurses specialising in cardiac surgery, as well as information technology teams and suppliers of Internet of Things (IoT) devices. The study falls into areas of digital health such as remote patient monitoring, the design of user-centred digital solutions and m-Health.
What is the context?
According to the World Health Organisation, cardiovascular disease remains the leading cause of death worldwide, responsible for around 17.9 million deaths a year. Its high prevalence is associated with unhealthy lifestyles characterised by poor diet, sedentary lifestyles, alcohol consumption, smoking and chronic stress, factors that contribute to persistent inflammatory processes and changes in the structure and function of blood vessels.
These vascular alterations favour the formation of fatty plaques (atherosclerosis) which progressively obstruct blood flow, leading to various cardiovascular diseases. These include high blood pressure, arrhythmias, coronary heart disease (obstruction of the arteries that supply the heart muscle), heart failure (impairment of the heart’s contractile function to pump blood effectively). Without early detection and intervention, these conditions can develop into serious acute events such as acute myocardial infarction, cerebrovascular accident (CVA) or even multiple organ failure due to insufficient circulation of blood and oxygen.
When the pharmacological approach is not sufficient, surgical intervention becomes necessary to restore cardiovascular function. However, despite their clinical efficacy, these interventions carry risks in the post-operative period, including arrhythmias, infections, thromboembolic events (formation of blood clots) and haemodynamic instability (persistently abnormal blood pressure). Hospital readmission rates range from 15% to 20% in the first month, and up to 30% over the first year after surgery.
What are the current approaches?
Currently, post-operative monitoring in cardiac surgery begins in a hospital environment, with intensive monitoring by doctors and nurses. Vital parameters such as heart rate, blood pressure, respiratory function, oxygenation, temperature, urine output and water balance are assessed, which are essential for early detection of complications and for guiding immediate clinical interventions. After hospital discharge, patients are integrated into cardiac rehabilitation programmes that combine the control of cardiovascular risk factors (hypertension, diabetes, obesity and sedentary lifestyle), the adjustment of pharmacological therapy according to clinical evolution, supervised exercise and educational support. The latter promotes health literacy, reinforces adherence to treatment and offers emotional support during the recovery process.
In recent years, remote monitoring solutions have emerged, mainly applied to chronic heart disease and to remote rehabilitation programmes. These approaches are based on the collection of physiological data via wearables and mobile applications, allowing patients to be monitored after returning home. However, they were not designed for the immediate post-operative period, characterised by greater clinical instability and the need for intensive monitoring. In addition, many have interfaces that are poorly adapted to patients in the recovery phase, lack structured mechanisms for real-time clinical response and are not integrated into hospital clinical flows, which makes it difficult for multidisciplinary teams to use them and jeopardises the continuity and effectiveness of follow-up.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consisted of the development of a structured digital system for the remote monitoring of post-cardiac surgery patients, with continuous home monitoring, coordination with the healthcare team and functionalities centred on the recovering person.
The development process followed the Design Science Research methodology, which favors the phased creation of solutions with continuous validation in real contexts. In parallel, the principles of Lean Startup were applied, which are based on the use of resources already available and rapid improvement based on feedback. In this case, the existing Digital Health Kits were used as a starting point for the development of the minimum viable product. Each kit included a smartphone with a 4G connection, ensuring continuous connectivity, a smartwatch for heart rate monitoring and step counting, a sphygmomanometer for measuring blood pressure and resting heart rate and a digital scale for monitoring body weight. All the IoT devices, were interconnected with the SMARTBEAT mobile application, developed as part of the project.
The app automatically collected the patient’s physiological data, while the patient submitted daily photographs of the surgical wound through a guided chatbot. In response, the patient received personalized educational messages, pre-defined, with the aim of strengthening health literacy throughout recovery. In addition, health professionals could send additional messages tailored to the clinical status of each patient.
A web platform was also developed for healthcare professionals, enabling real-time access to submitted data, management of clinical alerts, recording of interventions and structured monitoring of clinical progress. Although it doesn’t replace face-to-face contact, it provides complementary support for surveillance, facilitating the prioritisation of cases and supporting more informed clinical decision-making.
To assess the impact of this system, a pilot study was carried out at the Santa Marta Hospital in Lisbon, involving 30 patients undergoing cardiac surgery. Each patient was remotely monitored for 30 days, but the study was conducted over a period of 16 months, as improvements were introduced between monitoring cycles. The evaluation was organised into four successive cycles of development, testing and adaptation, allowing for continuous evolution of the solution according to the clinical context and user feedback. The analysis considered five main dimensions: (1) user experience, measured using the Net Promoter Score, the User Experience Questionnaire and face-to-face interviews; (2) adherence, assessed based on the regularity of data reporting throughout the monitoring period; (3) clinical feasibility, measured by the actual use of the platform by healthcare teams and the type of interventions recorded; (4) clinical effectiveness, assessed by comparing the incidence of critical events (such as hospital readmissions, re-interventions and mortality) between the monitored group and a historical control group; and (5) technical robustness, monitored through occurrences related to device or digital infrastructure failures.
What are the main results? What is the future of this approach?
The results of this study showed that the system developed was largely successful. Patient satisfaction with the experience was 88%. Adherence to daily monitoring was also high, with an average of 91.6 per cent of days with data reporting. In terms of clinical effectiveness, there was a statistically significant reduction in the occurrence of critical events, namely hospital readmissions, in the group of monitored patients compared to a historical control group (p=0.01). The system also proved highly feasible for integration into clinical practice, with 25 nurses and 2 surgeons actively participating in the use of the digital platform. Technical robustness was validated by the low incidence of failures in the IoT devices used. The functionality of sending personalised educational messages via chatbot was highly valued by patients, contributing to strengthening health literacy and an increased sense of security during the recovery process.
A randomised clinical trial with around 300 patients is planned, with the aim of more robustly validating the benefits observed, as well as identifying subgroups that could benefit more significantly from telemonitoring. At the same time, the application of predictive models based on machine learning is being developed, using the data collected to anticipate adverse events and support personalised clinical decisions. The methodology and technological infrastructure created are also considered replicable for other clinical contexts, particularly in highly complex surgical areas.
Would you like to know all the details?
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A Novel Approach for Robotic-assisted Tele-echography
Currently, robotic systems for ultrasound diagnostic procedures fall into two main categories: portable robots that require manual positioning and fully autonomous robotic systems that independently control the ultrasound probe’s orientation and positioning. Portable robots rely…
From Big Data to Big Decisions: How AI Stratifies Cancer Cases by Risk Factors
The CLARIFY Decision Support Platform (DSP) is a responsive web application designed to support decision-making in cancer care through real-time data integration and predictive analytics. Built on Big Data Europe, the platform integrates a variety…
From “Free Text” to Structured Clinical Data: the Foundation for Clinical Decision Support Systems
Currently, the practice of recording clinical information in “free text” offers flexibility, but hinders automatic data extraction, limiting the application of analytical models. Most records are unstructured, and the use of non-standard abbreviations increases ambiguity,…
Artificial Intelligence used in Depression Detection in Cancer Survivors
The goal of the FAITH project (Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment) is to remotely identify and predict depressive symptoms in cancer survivors using a federated machine learning approach…
Integration of SONHO v2 and SClínico Systems at ULS of Coimbra to Improve Healthcare Services
With more than half a million hospital medical consultations carried out in the first half of 2024, the ULS of Coimbra stands out as an institution dedicated to integrated, high-quality and patient-centered healthcare, with 8…
Elderly Care Ecosystem: an Innovative Platform for Personalized and Efficient Services
The Elderly Care Ecosystem (ECE) is an integration of various digital health technologies, exploring the areas of telehealth and predictive analytics. The goal of this ecosystem is to improve the quality of life for elderly…
Innovative technology that subconsciously relieves anxiety through a scarf
The SCAARF technology aims to offer an alternative method to alleviate anxiety symptoms in a non-intrusive and subconscious way. This technology is an innovative idea in the field of digital health and wearable technology, designed…
Digital Health Interventions: Equity in Hypertension Care for Everyone
Nearly half of all adults in the United States have hypertension, one of the leading risk factors for cardiovascular disease, and only about a quarter (24%) of those people have their hypertension under control. Studies…
Personalization and Technology in Diabetes Management
IPDM has significant potential to improve diabetes management and drive health system reforms to become high-performing, effective, equitable, accessible, and sustainable. Evidence and good practices inspire health system transformation. Adopting person-centred approaches like co-creation and…
Negotiations on the European Health Data Space Advance With the Participation of the SPMS
The European Health Data Space will be a common health data sharing system across the European Union. It foresees the use of data for purposes that benefit people and society. It will ensure citizens have…
Secretary of State Margarida Tavares Emphasizes Digital Innovation in Health Promotion
Margarida Tavares spoke at the opening of the conference ” O Digital na promoção contínua da saúde e do bem-estar”, organized by the Associação para a Promoção e Desenvolvimento da Sociedade da Informação (APDSI) and…
ARS Algarve Modernizes Radiology With AI and New Data Center
The radiology service of ARS Algarve has already performed nearly 29,000 exams using Artificial Intelligence (AI) technology. In recent years, there has been a significant investment in image digitization and data storage, as well as…
European Health Data Space: Unified Access To Health Data In The EU
The COVID-19 pandemic highlighted the importance of digital services in health, but complex rules and increasing cyberattacks make it difficult to share data across Member States; the EHDS, based on several regulations, provides tailor-made rules…
European Commission Amends Digital Europe Programme With an Investment of €762.7 Million
The European Commission has amended the Digital Europe Programme work programmes 2023-2024, investing an additional €762.7 million in Europe’s digital transition and cybersecurity. The digital transition is the main work programme with a budget of…
SPMS Integrates the TEF-Health Initiative
SPMS participates in the TEF-Health initiative as a partner in a consortium composed of 51 entities from 9 European Union countries. This action is co-financed by the European Commission and has a duration of five…
FMUP Creates Inhealth Junior Academy for High School Students
The InHealth Junior Academy — Academia Júnior de Inovação em Saúde is an initiative of the Departamento de Medicina da Comunidade, Informação e Decisão em Saúde da Faculdade de Medicina da Universidade do Porto (FMUP)….
SPMS Represents Portugal as Vice-president of GDHP
The GDHP is an intergovernmental organization in the digital health sector that facilitates cooperation and collaboration between government representatives and the World Health Organization (WHO). Its purpose is to foster policymaking that promote the digitalization…
Digital Transformation of Health at INCoDe.2030 in Tomar
The “National Digital Skills Initiative e.2030, Portugal” (INCoDe.2030) is an initiative that aims to improve the Portuguese population’s level of digital skills, placing Portugal at the level of the most advanced European countries in this…
Braga Hospital Evaluates Memory With Interactive Game in Patients With Multiple Sclerosis
Multiple Sclerosis is known as a chronic disease of the central nervous system, with a wide variety of motor and sensory symptoms that can lead to work disability, socioeconomic burden, and reduced quality of life…
Neurosurgery Teleconsultation Wins Innovation Award
The aim of the BI Award for Innovation in Healthcare is to recognize innovative projects in the healthcare sector that improve the quality of life for the Portuguese people. In 2021, the specific theme was…
HealthData@PT: New SPMS Initiative for Health Data
Action HealthData@PT is launched in the context of the implementation of the European Health Data Space, and is an initiative approved by the European Commission under the EU4Health 2021-2027 programme. This initiative contributes to the…
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