Remote heart care expands across Rochester region

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Heart care in the Rochester region is increasingly moving beyond traditional hospital and office settings, with providers using technology and home-based services to reach patients earlier and manage chronic conditions more effectively.

At the University of Rochester Medical Center, Dr. Neil Gupta, M.D., a cardiologist, is helping lead a pilot program aimed at addressing one of the most common and dangerous cardiovascular risk factors: uncontrolled high blood pressure.

“Traditionally, when someone is diagnosed with hypertension, it can take months or even years to get their blood pressure under control,” Gupta said. “That’s a lot of time that we’re missing.”

The hypertension pilot enrolls patients with significantly elevated blood pressure and provides them with blood pressure cuffs that automatically transmit readings to a secure online platform. After an initial in-person visit to set up technology, clinicians can monitor trends remotely.

Rather than waiting weeks between office visits to check blood pressure readings, Gupta and his team review average readings over two- to three-week periods and make medication adjustments in real time.

“The goal is to get people to their blood pressure target as quickly as possible,” he said. “We know that doing that significantly reduces the risk of heart attacks and strokes.”

This approach has proven especially valuable for underserved populations, Gupta said, including patients from UR Medicine Cardiac Care’s office at Anthony L. Jordan Health Center in Rochester, a Federally Qualified Health Center, where patients often rely on public transportation.

“Transportation barriers that can delay care, particularly during the winter months,” Gupta said. “With this approach, we can provide care in the 21st century, at home. It’s a tremendous benefit for patients.”

The pilot also incorporates wearable technology, including Fitbits, which provide clinicians with a clearer picture of patients’ daily activity levels and overall cardiovascular health between visits.

For example, low step counts can prompt conversations about movement, weight management, and overall cardiovascular health. Some wearables can also track overnight oxygen levels, which may signal undiagnosed sleep apnea — another contributor to heart disease.

“Wearables allow us to move quicker,” said Gupta, who notes that while wearables are not diagnostic tools on their own, they can help identify issues earlier and support faster intervention.

Early results of the hypertension pilot have been encouraging. Gupta recalled one patient whose systolic blood pressure dropped from about 160 to 120 over five months through remote monitoring and medication adjustments.

“It’s definitely satisfying to see and to know we’re making a difference,” Gupta said.

For patients already living with advanced heart disease, Rochester Regional Health‘s eHealth at Home program takes care beyond the clinic and into the home.

“With heart failure, timing is everything,” said Patricia Oates, PA, lead heart failure advanced practice provider and ventricular assist device manager with the Sands-Constellation Heart Institute at Rochester General Hospital. “The eHealth at Home program allows us to be proactive instead of only reactive.”

Oates describes the eHealth program as a critical shift in managing heart failure. Established several years ago and continuing to grow, it combines home visits from nurse practitioners and nurses with advanced telemedicine tools and close coordination with patients’ cardiology teams.

The program focuses on high-risk heart failure patients, helping ensure medications are optimized, symptoms are addressed early, and hospitalizations are avoided whenever possible.

Team members conduct in-home assessments, review medications, and provide education on diet and self-care. They closely monitor weight changes, breathing, and overall condition. If concerns arise during a visit, clinicians can make medication adjustments immediately and collaborate directly with cardiology providers seven days a week.

“Patients have direct access to our team,” Oates said. “If something doesn’t seem right, we can intervene right away.”

Technology is central to the program. In addition to telehealth visits, clinicians sometimes use specialized tools such as wearable vests that assess fluid volume status, a key indicator in heart failure. Some patients also have implanted pulmonary artery pressure monitors that transmit daily readings, allowing providers to detect changes before symptoms worsen.

“Those numbers often increase before the patient becomes symptomatic,” Oates said. “That helps us get ahead of it.”

The program has expanded over time. While initially used primarily by cardiology teams, primary care providers, hospitalists, and other specialists can now place referrals. Each referral is reviewed to determine whether the patient is appropriate for home-based care.

One particularly impactful feature of the eHealth at Home program is the ability to administer IV diuretics, such as Lasix, in the home; a treatment that traditionally requires an infusion center visit or hospitalization.

“Sometimes patients just can’t get to the office,” Oates said. “Being able to do that at home makes a huge difference.”

Ultimately, the goal of the eHealth program is to help patients remain stable, informed, and comfortable in their own homes.

“It’s a strong collaborative relationship,” Oates said. “And it’s huge for our community.”

Caurie Putnam is a Rochester-area freelance writer.