Remote blood monitoring could be the future for patients with pulmonary hypertension, thanks to funding from Janssen Pharmaceuticals for a research project at Royal Brompton and Harefield hospitals.
Led by Dr John Wort and Dr Laura Price, consultants in pulmonary hypertension, the research project aims to determine whether a certain disease biomarker, known as NT-proBNP, can be measured from a patient finger-prick blood sample sent via the post and if it is comparable to a regular hospital blood test taken at clinical appointments.
Diagnosing and managing pulmonary hypertension
Pulmonary hypertension is high blood pressure in the blood vessels that supply the lungs (pulmonary arteries). In pulmonary hypertension, the walls of the pulmonary arteries become thick and stiff, increasing the resistance to blood flow. In addition, sometimes, blood vessels are blocked or partially blocked by blood clots.
The resistance to flow of blood makes it harder for the right side of the heart to pump blood through the pulmonary arteries, causing the right side of the heart to work harder. Gradually this causes the right side of the heart to become weaker and can lead to heart failure.
NT-proBNP (or brain natriuretic peptide) is a molecule that is released from the walls of the heart when they are under stress. It is used as a marker of heart failure and has been very helpful in monitoring the progress of patients with pulmonary hypertension.
Currently NT-proBNP (and a related molecule called BNP) is measured using blood taken from the arm, known as a venous blood sample. However, with the increase in remote appointments (using telephone and video technology), it has become increasingly difficult to obtain the necessary blood sample and this therefore limits the amount of useful information that can inform a physician or nurse about a patient’s progress.
Research on remote blood monitoring
One way around this problem is to use finger-prick samples which can be taken by the patients at home and then sent to a laboratory via the post.
However, given the importance of the actual value measured, clinicians need to investigate the reliability and accuracy of this method against the standard method of measuring NT-proBNP taken in the hospital environment with a venous blood sample.
The funding will allow the research team to directly compare the method of blood sampling from a fingerpick against the standard venous blood sample. The research will also look at whether delays in the post can affect the values at 3 days and 7 days after the sample is taken.
Dr Wort said: “This study will tell us if we can rely on remote monitoring of this important marker of heart failure in patients with pulmonary hypertension. If we can, it will really increase the amount of important information we can get from remote consultations, especially as these will be part of patient care moving forwards. So, although a relatively simple study, the results should have big implications.”
So, what could this mean for patients?
If the study is succesful, Dr Price believes that "it will show that we can effectively monitor patients remotely, so they may only need to come in for more tests only if there is a rise in the NT-proBNP value. Patients will need to travel into London to see us less often, and we can target their planned tests better."
Eleanor Morris, the lead research nurse for the project, is hopeful about the study and said: “The project addresses both a data deficit within the understanding of the markers of cardiac function and the limitations of tele-consultations in providing clinical results which can be implemented for future care. If successful, implementing the results could provide far-reaching improvements to patient experience, care, and outcomes.”
The study is expected to start in March 2022 and will involve all the specialist pulmonary hypertension centres in the UK and led by Royal Brompton Hospital.
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