WILLMAR - Once upon a time, DuWayne Underthun and his wife, Betty, would have been making many snowy trips from their rural Willmar home to the CentraCare Heart and Vascular Center in St. Cloud for his congestive heart failure.
Instead, he now receives most of his care much closer to home through a newly launched heart failure telemedicine program at Rice Memorial Hospital.
An appointment last week, the day after a snowstorm pummeled the region and brought most travel to a standstill, reinforced the value to the Underthuns of local access to quality care.
"We would not have been able to make it to St. Cloud because of the weather," said DuWayne Underthun, 78. "This is much more convenient."
RELATED STORY: Minnesota sees steep rise in telemedicine use
The telemedicine service, a satellite of the CentraCare Heart and Vascular Center, combines technology and clinical expertise to bring local care for congestive heart failure to a higher level.
It's something that was needed, said Roxanne Covert, a Carris Health registered nurse certified in heart failure and coordinator of the program in Willmar.
"It took three years but we're there and it's pretty exciting," she said.
Congestive heart failure looms large as one of the chronic health conditions in an aging population that will require increasing attention and resources.
Seen most often in the 65-and-older population, it is the leading cause of hospital admissions in the United States. It's also the fastest-growing cardiovascular disease in the U.S. - and the costliest.
The good news is that people can still live well after a diagnosis of congestive heart failure. "The outcomes are better. People live longer," said Dr. Jamie Pelzel, a cardiologist at the CentraCare Heart and Vascular Center and medical director of the heart failure clinic.
The challenge is bringing the latest and best in care to communities where patients live, especially when they happen to live in rural Minnesota.
A goal of the telemedicine service is to narrow this gap, said Pelzel.
For these patients to do well, it's important to have access to ongoing chronic care management, he said.
"We know that when people come into the hospital and have congestive heart failure, there's a 1 in 4 chance they'll end up back again within 30 days. ... When people are able to stay out of the hospital, able to manage their chronic illness, that translates into better overall quality of life."
Advances in technology have made telemedicine more viable and have reduced the barrier that distance can create, Pelzel said.
"I think we underestimate how big a deal that is," he said of the travel often required for rural residents to obtain specialized care.
Underthun is the first patient to use the new service.
Like many people, the first signs of his congestive heart failure were subtle. "My legs got weaker," he recalled, but he dismissed it as something that ran in the family.
Then one weekend this past October, things worsened.
"I couldn't get my breath. I was out in the pole barn and I had to sit down," he said.
A visit to urgent care turned into a trip to St. Cloud Hospital, where he stayed for four days. He had had a heart attack. While at the hospital, he and Betty learned he also had congestive heart failure that most likely began a few years earlier.
In the days and weeks following a heart failure diagnosis, there's a lot to absorb, Covert said. Patients typically have several new medications and may undergo numerous dose adjustments. They often must change familiar eating patterns to restrict salt intake. They have to adopt new habits to manage their condition, such as weighing themselves often to monitor weight gain that might signal increased fluid retention. They have to learn what to watch for and when a symptom is worrisome enough to take action.
The learning curve is steep, Betty Underthun said. "It's not easy."
There's also an emotional adjustment.
"It can't be me. It's somebody else," was DuWayne Underthun's initial reaction. "But it was. It takes a little while to accept that."
Covert has been their go-to resource in Willmar, providing education, clinical management and reassurance.
"There's so much we can do for this disease," she said.
The telemedicine visits with clinical specialists at CentraCare Heart and Vascular Center bring a layer of advanced care that wouldn't otherwise be locally available.
A patient in Willmar and a clinician in St. Cloud can see and speak to each other via the two-way connection. From St. Cloud, a mini-camera can be manipulated to get a close-up look at the patient's ankles to check for swelling. Heart and lung sounds through a stethoscope in Willmar are transmitted to St. Cloud where the clinician can hear them through headphones.
Three months after his diagnosis, Underthun is doing well. He quickly grew comfortable being on camera, and he and Betty appreciate the access to skilled clinicians both in their hometown and in St. Cloud.
"They know what they're doing. I'm thankful for that," he said.
Willmar is the first satellite to offer the service. It's hoped that more sites will be added to broaden the outreach that CentraCare Heart and Vascular Center can provide.
"We want it to grow. We know that patients will benefit," Pelzel said.
The goal isn't to replace local care with telemedicine but to expand what can be provided locally and bring more diverse knowledge to the team, he said.
"It's the people on each end who are what really matter. This is more than setting up the technology. We've been co-managing patients. We're only enhancing what's already taking place."