Telemonitoring

Background: Chronic heart failure represents a major public health challenge, affecting approximately 64 million people worldwide and generating high costs in terms of mortality, frequent hospitalizations, and medical expenses. In France, this disease is expected to cause nearly 70,000 deaths and 181,000 hospital admissions in 2022. Current management, based on periodic consultations, fails to effectively prevent acute exacerbations, highlighting the importance of technological solutions such as remote monitoring. Objective: This study aims to demonstrate the value of regular monitoring of electrophysiological and mechanical cardiac signals and parameters in patients with chronic heart failure. Its goal is to build a database of signals from an external measuring device (MyHeartSentinel MHS) to identify parameters that evolve in relation to biological and/or hemodynamic changes and/or the patient's clinical status. The results of this study will enable the further development of an automated monitoring solution for heart failure patients to enable early detection and management of decompensation. Materials and Methods: A total of 70 patients diagnosed with chronic heart failure will be included, including 30 patients hospitalized for heart failure decompensation and 40 patients hospitalized for hemodynamic assessment. Electrophysiological and cardiac mechanical data will be collected using a skin-based measuring device. These data will then be correlated with biological and/or hemodynamic changes and/or the patient's clinical status. They will contribute to the training of an algorithm to detect the risk of decompensation. Hypothesis Tested: Ability of MHS to detect electrophysiological and cardiac mechanical data related to cardiac decompensation, such as cardiac filling pressure.

Postoperative hospital stays and complications vary widely after digestive surgery. Enhanced Recovery After Surgery (ERAS) protocols have shortened stays and accelerated recovery after elective procedures, but they remain challenging in emergency surgery and among frail or elderly patients. While theoretical discharge after colorectal surgery is possible between postoperative days 2 and 7, average stays in practice are 12-14 days. Bariatric surgery similarly targets discharge on days 2-3, yet typical stays are 8-10 days. Patients successfully managed under ERAS may face higher readmission risk, often due to worsening comorbidities or serious complications. Prolonged hospitalization and readmissions impact patient safety, comfort, and healthcare costs. Daily hospital costs in surgical units range from €350 to €400. Post-acute care facilities can reduce readmissions but often have long waiting periods. To minimize readmission risk, many surgeons prefer in-hospital postoperative monitoring, limiting early discharge. Recent studies show that connected devices and teleconsultation can provide safe and effective postoperative follow-up. Teleconsultation follow-up is feasible for most patients, with satisfaction rates comparable to in-person visits. Remote monitoring of stoma care has been associated with reduced readmissions. Home-based monitoring using connected vital sign devices in high-risk patients reduces readmissions and emergency visits. In colorectal and bariatric surgery, daily remote monitoring after early discharge (24-48 hours) did not increase morbidity or readmission, suggesting that telemonitoring can safely enable earlier discharge while maintaining patient safety. Continuous monitoring is particularly important for high-risk patients due to rapid deterioration from potential complications. EPOCA is a telemonitoring and telecoordination platform providing medical, paramedical, and social follow-up at home. It combines connected devices, a digital platform for data analysis, and a dedicated medical and paramedical team. Services include teleconsultations, home paramedical care, support for families or care facilities, and 24/7 emergency management. EPOCA reassures patients and caregivers, supports primary care and home care teams, and integrates hospital and emergency services. It addresses challenges posed by aging populations, chronic disease prevalence, and increasingly complex patients. By enabling earlier discharge without increasing readmissions, EPOCA offers a holistic solution bridging hospital and home care. It has already demonstrated success in preventing hospitalizations in high-risk elderly patients and is authorized for telemonitoring of chronic conditions including diabetes, respiratory, renal, and cardiac insufficiency. This study aims to evaluate the feasibility of implementing EPOCA over two years in the CHU Nantes digestive surgery unit. It will target patients undergoing elective or urgent colorectal or bariatric surgery who are at risk of prolonged hospitalization or readmission. High-risk scenarios include anticipated early discharge within 24 hours and patients identified as having elevated readmission risk according to predefined criteria

The overall aim of this research proposal is to explore the feasibility and acceptability of home antenatal maternal-fetal monitoring technology within a high-risk pregnancy group. The investigators hypothesise that home monitoring is feasible and acceptable to both pregnant women and HCPs. 50 women from a single site will be recruited to use a home cardiotocography (CTG) device alongside routine antenatal care. Participants will use this device once a week, for an hour at a time, for up to 6 weeks or until delivery. The primary outcome is 20 minutes of continuous monitoring. Additional outcomes assess acceptability, adherence and safety.

Non-pharmacological, randomized, nonprofit medical device intervention. The study aims to identify the positive impacts (co-creation), and negative impacts (co-destruction), resulting from the use of telemedicine, and, in particular, the telemonitoring service for patients with heart failure