(691) Empowering patients to conduct NSTs from home: Success rates from over 2000 remote NSTs

Many pregnancies require multiple, in-person non-stress tests (NSTs), adding significant patient burden. Novel technologies can enable remote NSTs; however, the feasibility of this solution in real-world, clinical settings remains uncertain. We analyzed success rates for patients conducting home NSTs under the remote supervision of their healthcare providers.

Study Design:

In this retrospective study, we queried an anonymized database to identify remote NST appointments conducted using an FDA-cleared, remote fetal monitoring device. All NSTs were prescribed and remotely monitored by local healthcare providers. We included remote NSTs conducted ≥32 wks outside of a medical office or research trial and excluded sites with < 10 NSTs. The primary outcome was successful NST appointment, defined as one with a clinically interpretable NST, as documented by the provider. An appointment window was defined as a day in which a remote NST was attempted. For one site conducting twice daily NSTs for de-hospitalized patients, the appointment was a half-day. We analyzed maternal age, pre-gravid BMI, gestational age (GA) and appointment number (appt#) as predictors of success.

Results:

Between July 2022 and June 2024, 2080 NST appointments we performed in 227 subjects across 10 clinical sites. After excluding 5 subjects and 59 NSTs with no provider documentation, 2031 NST appointments in 222 patients were analyzed. A successful NST was obtained in 92.9% (N=1887) of appointments. NST success was not related to maternal age (p=0.51) but was associated with GA (P< 0.01), lower BMI (P< 0.01) and higher appt# (P< 0.01), with the appt# having the greatest impact on success variance (Table). Success rates < 85% were observed for first appt# (81%) and BMI≥50 (72%) (Figure). 

Conclusion:

Antenatal fetal surveillance is critical to reducing adverse pregnancy outcomes but adds significant burden. Remote NSTs can empower patients to access care from home, while remaining under healthcare team supervision. Our results demonstrate that patients can successfully obtain clinically interpretable NSTs at home in a real-world setting.