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Updated: Sep 4, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Utilizing technology to expand home monitoring to high-risk infants with CHD
Dana Hartman1, Eric Ebenroth2, Anne Farrell1
1Riley Hospital for Children at Indiana University Health, Pediatric Cardiology, 705 Riley Hospital Drive, Indianapolis, USA.
Insights
Home monitoring programs significantly reduce interstage mortality in infants with single ventricle physiology, improving caregiver confidence and program efficiency. This digital approach enhances care for high-risk neonates.
Area of Science:
- Pediatric Cardiology
- Medical Technology
- Neonatal Care
Background:
- Infants with single ventricle physiology and aorto-pulmonary shunts face high sudden cardiac death risk during the interstage period.
- Home monitoring programs have previously reduced interstage mortality in hypoplastic left heart syndrome (HLHS) populations.
- Expansion of home monitoring to other high-risk infant populations is warranted.
Purpose of the Study:
- To implement and evaluate the Locus Health digital home monitoring platform in high-risk single ventricle infant populations.
- To assess the impact of digital home monitoring on interstage mortality and caregiver experience.
- To determine program engagement, adherence, and reimbursement rates.
Main Methods:
- Implementation of the Locus Health platform for HLHS and single ventricle shunt populations.
- Analysis of interstage mortality rates before and after home monitoring implementation.
- Caregiver surveys to evaluate experience and confidence with the digital platform.
- Tracking of patient episodes, engagement, adherence, and insurance reimbursement.
Main Results:
- Interstage mortality for HLHS decreased from 18% pre-2009 to 7% by 2020, with 0% mortality since 2017 with the Locus program.
- 91.8% of caregivers reported feeling confident caring for their baby at home using the digital application.
- Caregiver engagement and adherence rates were 50.94% and 45.45%, respectively; 22% reimbursement was achieved in 2020.
Conclusions:
- Digital home monitoring, exemplified by the Locus Health platform, effectively reduces interstage mortality in high-risk single ventricle infants.
- The transition to a digital platform enhances caregiver confidence and program scalability, integrating with electronic medical records and enabling billing.
- While caregiver engagement and reimbursement present challenges, the positive impact on infant outcomes and caregiver experience is significant.
Abstract:
Infants born with single ventricle physiology that require an aorto-pulmonary shunt are at high risk for sudden cardiac death, particularly during the interstage period between the first-stage palliation and the second-stage palliation. Home monitoring programs have decreased interstage mortality in the hypoplastic left heart syndrome population prompting programs to expand the home monitoring program to other high-risk populations. At our mid-sized program, we implemented the Locus Health home monitoring platform first in the hypoplastic left heart syndrome population, then expanding to the single ventricle shunt population. Interstage mortality for the hypoplastic left heart syndrome population after initiation of the home monitoring program went from 18% prior to 2009 to 7% as of the end of 2020 (n = 99), with 2.8% mortality from 2013 to 2020 and 0% mortality since initiation of the Locus program in 2017. Caregiver surveys done prior to discharge and then 3 weeks later were used to document caregiver experience using the digital home monitoring program. Caregivers reported overall positive experience with the digital application, with 91.8% stating that they felt confident taking care of their baby at home. Transitioning the home monitoring program from a traditional binder to an iPad with the Locus Health application allowed us to expand the program, utilize the electronic medical record, bill for the service, and demonstrate positive experiences for caregivers. Overall engagement and adherence with the program by caregivers were 50.94 and 45.45%, with a total of 112 patient episodes. Reimbursement from private insurance providers was 22% of the billed amount for 2020.
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