What is corvadis®?

corvadis® by HCSG

Telecoaching and telemonitoring services for patients with congestive heart failure (CHF)

Patients with CHF frequently mistake their symptoms as appropriate for their age, whereas these symptoms can indicate a decompensation. If not given timely and appropriate treatment, a decompensation can result in hospital admission, frequently as an emergency case on an intensive care unit (ICU).

Telecoaching

corvadis® educates and coaches patients individually to identify their symptoms in a correct and timely manner and to effectively change their behavior with supportive guidance.

How we coach

Telemonitoring

corvadis® monitors the symptoms critical to CHF daily. If a person's condition does not improve, the patient will be advised to see her or his physician.

How it works

Benefits

corvadis® is based on the latest medical-scientific telecoaching.guidelines. It was developed by leading experts in the fields of heart failure, telecoaching and telemonitoring. These programs have been demonstrated to reduce mortality, hospital admissions, and health care costs while improving quality of life.

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corvadis® supports keeping patients out of the hospital.

Watch the mecor® video

Telecoaching

 

Telecoaching

corvadis® helps to break lifelong-established behaviors.

corvadis® educates and coaches patients individually to identify their symptoms in a correct and timely manner and to effectively change their behavior with supportive guidance.

 

Useful Tips

corvadis® provides patients with easy and useful tips for their daily life.

corvadis®-nurse services are not restricted to education and advice. Additionally, they provide continuous coaching on realizing change by setting of individual goals in small and achievable steps.

Coping with thirst

CHF patients should restrict their fluid intake to ice cubes if they feel they cannot uphold the water restriction under hot conditions.

Salt and nutrition

For instance, CHF patients should reduce salt in cooking. Instead, it’s suggested they reach for herbs or spices to flavor their food.

Physical activity

A certain amount of physical activity is beneficial for CHF patients. They are asked to handle the required changes in small and achievable steps.

Adherence to medication

Medication prescribed by the physician must be taken on a regular basis and regardless of distress. Using a pill dispenser can be helpful.

In many cases, patients are counseled to change behavior established over a lifetime, which can be a significant challenge given the average patient age of 75 years.
See an example

Example

Fluid intake

 

Patients have learnt throughout their lives to drink a lot as this is good for their kidneys.

While this is generally true, CHF patients often must restrict their daily fluid intake to a defined maximum as their weakened heart function is not able to handle higher volumes.

If these patients exceed their individually set maximum, water can accumulate in the body, for example in the ankles or more severely in the lungs, causing respiratory difficulties. The resulting cough might again be mistaken, in this case to a cold.

 

Changing lifelong established behaviors

With the support of specifically trained nurses, patients learn to understand that all fluid intake - not just water and coffee, but also fluids from fruits and vegetables - count against their daily allowance.

They also get practical tips and advice, such as to use ice cubes instead of drinks if they feel they cannot uphold the water restriction under hot conditions.

 
 
 
 

Patient centricity

Leading the patient - the individual approach of corvadis®

Guided by the unique corvadis® software, nurses consider the specific situation of each patient and can get a comprehensive understanding of both the medical and social conditions faced by the telecoaching.

Rather than only relying on the individual assessment of a nurse, corvadis® applies in addition an algorithmic approach to consider all the various factors relevant to relations with the telecoaching.
Details
 

Medical situation

CHF is not a stand-alone disease but is most often a result of various conditions and lifestyle choices, such as smoking and physical inactivity. This can cause problems such as high blood pressure or other comorbidities, which may lead in the end to CHF. Therefore, corvadis® nurse care will also cover the comorbidities and will tackle the root issues that present the biggest challenge to the patient at the given time.

 

Social situation

Understanding the social situation of the patient is equally important; nurses will have to take into account whether patients are living alone as well as who is providing meals to the patient when it comes to nutrition.

 

Learning Style

Patients have highly differing styles of digesting information and coping with change. Nurses are confronted with highly educated academics as well as unskilled workers and the entire continuum in between. The challenge is to understand individual learning styles and to adjust education and coaching accordingly.

 

Psycho-social stratification

Patients are also provided with a comprehensive binder covering all aspects of their disease. While some patients will have read the entire binder before their next coaching session with the nurses, others will successfully participate in the program without ever having looked into the educational material. Moreover, many patients find it increasingly difficult to remember information.

 

Communication Type

As a result, nurses apply a set communication style. For instance, patients with a positive response to education will continuously receive new information regarding their disease, whereas patients who respond better to simple directions on what to do and what not to do will be instructed accordingly.

 
 
 
 
 

At all stages the care is centered around the patient who remains in control.

 

Supporting software

Smart and unique - the supporting corvadis® software

The unique design of the corvadis® software enables both an individual as well as a systematic approach based on the latest medical-scientific telecoaching.guidelines.

Individual learning compendium

Every aspect of the learning compendium is organized in a coordinated way. A task cannot be completed without covering certain essential subjects, while optional items are left for patients who have demonstrated aptitude.

Consistent use of language

Workflow sequence and language used by the nurses match the training materials provided in the binder. For example, nurses are trained (and software-led) not to use the term “diuretics” when the patient materials covering relevant medication talks about “water tablets.”

Guidelines-based and scalable

The systematic approach of the corvadis® software is based on medical guidelines and allows for a scalable solution to accommodate high patient numbers with a consistent and high quality design solution.

ESC-Guidelines

“It is clear that there is not just one type of telemedicine, and each approach needs to be assessed on its individual merit.”

*European Society for Cardiology, May 2016

Telemonitoring

 

Telemonitoring

corvadis® monitors the symptoms critical to CHF.

As a kind of “safety net” in addition to education and coaching, corvadis® monitors the signs and symptoms critical to CHF. If a person’s condition does not improve, the patient will be advised to see her or his physician.

See how it works
 
 
 
 
 
 
 
 
 
 
 
 
 

Monitoring weight

A typical morning for the patient starts with stepping on the corvadis® scale. Still sleepy or not, weighing oneself is easily done and the data is automatically transferred to the telemonitor. Almost all patients have adopted this habit.

Monitoring symptoms

The telemonitor greets the patient with a friendly “good morning” immediately after it records the weight from the scale. It then asks the patient a few questions regarding symptoms associated with heart failure – the same questions a doctor would typically ask a patient with CHF.

Monitoring symptoms

These questions can be responded to easily with either “Yes” or “No,” using two large buttons. No frills or gimmicks - everything is configured for the elderly. The transmission of data starts automatically at the end of this process, which takes less than a minute.

Data Processing

Patient data received by the corvadis®-telemedical center is processed algorithmically. Based on extensive experience, we have identified patterns of weight and symptom signals that go beyond established medical telecoaching.guidelines. Any red flag that could indicate a worsening of the condition is transferred to an experienced nurse.

Intervention

Nurses specifically trained to handle alarm routines will review the data and decide whether it's necessary to intervene by calling the patient. An intervention can range from simply reminding the patient of his routines (e.g., taking his medication) to more urgent situations when an unplanned visit to his or her regular doctor becomes necessary.

Physician

At all stages the care is centered around the patient who remains in control: Even if the nurse recommends a visit to the physician, the patient decides when he or she does so. Typically, the patient will agree to the nurse giving a brief report to the physician about the upcoming visit and the signs of worsening experienced by the patient.

With a slight modification in behavior or medication, the patient can go back to his daily routine without an admission at the hospital.

 
 
 
 

Hardware

Plug'n'Play

Our devices are delivered in a true “plug’n’play” manner, which literally requires only plugging in the A/C adaptor; everything else is individually pre-configured.
 

The corvadis® center receives an automatic status update of the device once it is successfully plugged in, and a dedicated team is available to support patients with any concerns regarding connectivity or usage of the telemetric devices.

Benefits

 

Benefits

corvadis® supports keeping patients out of the hospital.

corvadis® is based on the latest medical-scientific telecoaching.guidelines. It was developed by leading experts in the fields of heart failure, telecoaching and telemonitoring. Their programs have been demonstrated to reduce mortality, hospital admissions, and health care costs while improving quality of life.

The facts
 

Prevalence

Heart failure is a common disease.

Heart failure is a millstone around the neck of those who are individually affected, and it is also a significant socioeconomic burden on global healthcare systems. Being the final common pathway of a multitude of underlying cardiovascular diseases such as coronary artery disease or hypertension, its prevalence is about 2 % of the entire population in developed countries. Since the underlying diseases appear more frequently at an advanced age, heart failure is more frequent in the elderly as well: Up to 10 % of citizens beyond the age of 75 years suffer from heart failure.

 

Clinical Results

corvadis®

Heart Failure Healthcare beyond State-of-the-Art

According to the European Society of Cardiology, patients with heart failure benefit from regular follow-up and monitoring to ensure the safety and optimal dosing of medicines and to detect the development of complications or disease progression that may require a change in disease management.

For this reason, corvadis® provides remote monitoring of heart failure signs and symptoms. Comprehensive, structured telephone support for every important aspect of day-to-day life enables a self-determined and self-managed life even if plagued by heart failure.
Benefits in detail

Hospitalization

In most cases, heart failure is an incurable disease, and its natural history is characterized by alternations of periods of seeming calm and unexpected, sudden phases of deterioration. The latter routinely lead to hospital admission. Once the deterioration is serious enough that a hospital admission is required, prognosis is worsened not only in the short term, but also in the long run. Often, the former state of health cannot be attained even after successful hospital treatment.

Unfortunately, heart failure is marked by an appallingly high rate of short term hospital readmissions. About 25 % of patients who were discharged from a hospital have to be re-admitted within 3 months.

The situation is not only a dramatic destiny for all those concerned, since it is associated with high mortality, but it provides the basis for the healthcare cost explosion which is closely tied to heart failure.

 

A systematic review and metaanalysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in more than 8.000 patients derived from 25 publications was recently performed by the renowned COCHRANE collaboration.

In the recent COCHRANE review, both telemonitoring and structured telephone support reduced the risk of heart failure related hospitalizations by 21 % (risk ratio 0.79 [95 % confidence interval 0.67–0.94], P = 0.008) and 23 % (risk ratio 0.77 [95 % confidence interval 0.68–0.87], P < 0.0001), respectively.

Quality of Life

A key symptom of heart failure is an increasing loss of physical and mental fitness. The main consequences of this continuous and sometimes erratic decline in fitness are an increasing inability to live self-sufficiently, and progressive social exclusion and marginalization, respectively. Therefore, heart failure has a huge impact on quality of life.

Furthermore, it is closely associated with mental illnesses. The high prevalence of depressive disorders in patients suffering from coronary artery disease continues to rise up to 25 % once heart failure comes into play.

 

A systematic review and metaanalysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in more than 8.000 patients derived from 25 publications was recently performed by the renowned COCHRANE collaboration.

In the recent COCHRANE review, both telemonitoring and structured telephone support improved quality of life, reduced costs, and were acceptable to patients.

Three telemonitoring studies reported improvements in quality of life in mental and physical measures. Six studies of structured telephone support reported improvements in quality of life, with significant improvements in physical and overall measures.

Mortality

In Germany, heart failure is the fourth leading cause of death in men and the third leading cause of death in women. The situation appears to be similar in other developed countries.

Contrary to what one might expect, cancer steps back and in men, only lung cancer is a more prevalent cause of death than heart failure. In both men and women, only coronary artery and cerebrovascular diseases - both manifestations of a generalized arteriosclerosis and thus closely linked to heart failure - top everything.

 

A systematic review and meta analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in more than 8,000 patients derived from 25 publications was recently performed by the renowned COCHRANE collaboration (Inglis et al., 2011).

In the recent COCHRANE review, telemonitoring reduced the risk of mortality by 34 % (risk ratio 0.66 [95 % confidence interval 0.54–0.81], P < 0.0001) and structured telephone support showed a similar, but non-significant trend (risk ratio 0.88 [95 % confidence interval 0.76–1.01], P = 0.08)

 
 
 
 
 

Reduced health care costs, improved quality of life

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