An increasing need for PROMs in cardiology now and in the future
Patient-Reported Outcome Measures (PROMs) have an increasing role to play in medicine in the future. The emergence of the latest public health crises has highlighted the need for more innovative ways in which the medical community practices healthcare at a distance to ensure the safety of all. This coupled with the more patient-centred approach to treatment and an emphasis on quality of life paves the way for the more widespread, diverse use of PROMs in the coming years.
The scale of the problem
Cardiology is a branch of medicine that deals with disorders of the heart and its associated circulatory system. Therefore, the clinical landscape of cardiology is a vast one. Cardiology encompasses conditions such as: heart failure; coronary heart disease; cardiovascular disease; hypertension; congenital heart defects; arrhythmias and valvular heart disease to name a few. This subset of diseases are the most common non-communicable diseases globally, responsible for an estimated 17.8 million deaths in 2017, approximately 31% of all deaths worldwide each year.1
PROMs signal quality of life
This disease area is seismic and like cancer, patients are living with these conditions for longer than before with the advancement of therapeutics and increased disease awareness. A significant area of cardiology that is responsible for patient morbidity and death is heat failure, with 15 million people living with the condition in the EU alone. Major guidelines exist for heart failure management, recommending therapies that affect the course of the disease.
However, these guidelines most commonly focus on mortality, hospitalisation, or surrogate measures such as a change in ejection fraction or ventricular remodelling.2, 3 Quality of life is often noted as being a greater concern compared to longevity according to research conducted by Kraai et al., among patients living with such a condition.4 PROMs have a role to play in ensuring that the patient’s voice is documented and listened to to provide the best possible regime of care for the individual in order to optimise their everyday experience when living with chronic illnesses.
PROMs can highlight progression and therapeutic problems in cardiology
The longitudinal and frequent collection of PROMs from those living with cardiovascular diseases can highlight disease progression and any unforeseen problems that arise because of prescribed drug treatments. For example, increased bouts of breathlessness is often a crucial sign of disease advancement that may not be so obvious to the patient. Patient engagement with PROMs can prompt the patient to become more aware of such developments, with this having the potential to alert the patient care team at an earlier stage.
Additionally, cardiovascular therapies are becoming more complex and with that often comes side effects. PROMs have the power to highlight problems patients may be experiencing with prescribed medications and so changing them has been associated with significant improvements in patients’ health status and treatment adherence as seen by research conducted by Thomas et al. as measured via the 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Scale (KCCQ-OS). Moreover, the study results indicated that the use of PROM data may help clinicians in monitoring medication titration.5
PROMs in the future of cardiology
PROMs are set to have a more prominent role in the area of clinical trials with the FDA focused on involving the patient in drug development and assessing what is relevant and essential important to the patient for approval decisions and labelling.6 This is pertinent as the cardiovascular drug market is projected to reach USD 63.96 billion by 2026.6 Embedding PROMs in clinical studies is paramount to ensuring research aligns with patient- centered values, and in 2014, the European Society of Cardiology proposed their mandatory integration into future randomized control trials.7 However, despite this recommendation, the current standard of PROMs integration and reporting in trials remains poor in some areas such as cardiac catheter ablation.8
With more sensitive and advanced PROM sets tailored to cardiology emerging and an acknowledgement of the value of the patient voice in treatment, PROMs will become an indispensable aspect of monitoring cardiovascular diseases in the future.9 We at heartbeat medical are proud to support advancements in the field and strive to ensure that PROMs integration can be made seamless with our anamnesis and outcome measurement platform heartbeat ONE.