Telemonitoring in Patients with Heart Failure

Section of General Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
New England Journal of Medicine (Impact Factor: 55.87). 11/2010; 363(24):2301-9. DOI: 10.1056/NEJMoa1010029
Source: PubMed


Small studies suggest that telemonitoring may improve heart-failure outcomes, but its effect in a large trial has not been established.
We randomly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either telemonitoring (826 patients) or usual care (827 patients). Telemonitoring was accomplished by means of a telephone-based interactive voice-response system that collected daily information about symptoms and weight that was reviewed by the patients' clinicians. The primary end point was readmission for any reason or death from any cause within 180 days after enrollment. Secondary end points included hospitalization for heart failure, number of days in the hospital, and number of hospitalizations.
The median age of the patients was 61 years; 42.0% were female, and 39.0% were black. The telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point, which occurred in 52.3% and 51.5% of patients, respectively (difference, 0.8 percentage points; 95% confidence interval [CI], -4.0 to 5.6; P=0.75 by the chi-square test). Readmission for any reason occurred in 49.3% of patients in the telemonitoring group and 47.4% of patients in the usual-care group (difference, 1.9 percentage points; 95% CI, -3.0 to 6.7; P=0.45 by the chi-square test). Death occurred in 11.1% of the telemonitoring group and 11.4% of the usual care group (difference, -0.2 percentage points; 95% CI, -3.3 to 2.8; P=0.88 by the chi-square test). There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components. No adverse events were reported.
Among patients recently hospitalized for heart failure, telemonitoring did not improve outcomes. The results indicate the importance of a thorough, independent evaluation of disease-management strategies before their adoption. (Funded by the National Heart, Lung, and Blood Institute; number, NCT00303212.).


Available from: Jeph Herrin
    • "The collected data were subsequently reviewed by patients' clinicians. The study reported no significant difference in hospital re-admissions or mortality within 180 days from the enrollment between the two groups [2]. In [4], Clark et al. reviewed 14 randomized controlled trials (4262 patients in total) of tele-monitoring and/or structured telephone support for patients with CHF. "
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    ABSTRACT: We present a smartphone-based system for remote real-time tele-monitoring of physical activity in patients with chronic heart-failure (CHF). We recently completed a pilot study with 15 subjects to evaluate the feasibility of the proposed monitoring in the real world and examine its requirements, privacy implications, usability, and other challenges encountered by the participants and healthcare providers. Our tele-monitoring system was designed to asses patient activity via minute-by-minute energy expenditure (EE) estimated from accelerometry. In addition, we tracked relative user location via global positioning system (GPS) to track outdoors activity and measure walking distance. The system also administered daily-surveys to inquire about vital signs and general cardiovascular symptoms. The collected data were securely transmitted to a central server where they were analyzed in real time and were accessible to the study medical staff to assess patients' health status and provide medical intervention if needed. Although the system was designed for tele-monitoring individuals with CHF, the challenges, privacy considerations, and lessons learned from this pilot study apply to other chronic health conditions that would benefit from continuous monitoring through mobile-health (mHealth) technologies, such as diabetes and hypertension.
    Proceedings of the 9th International Conference on Body Area Networks; 09/2014
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    • "Most of the included studies were relatively small. The meta-analysis did not include two larger, more recent multi-center studies, Telemonitoring to Improve Heart Failure Outcomes (TELE-HF, 1,653 patients) [15] or Telemedical Interventional Monitoring in Heart Failure (TIM-HF, 710 patients) [16]. The Tele-HF intervention had no effect on all-cause readmission or death within 180 days, and no significant effect on secondary endpoints such as hospitalization for HF, hospital days, or time to the primary endpoint. "
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    ABSTRACT: Heart failure is a prevalent health problem associated with costly hospital readmissions. Transitional care programs have been shown to reduce readmissions but are costly to implement. Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed. The objective of this randomized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure. A multi-center, randomized controlled trial is being conducted at six academic health systems in California. A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure. Patients in the intervention group will receive intensive patient education using the 'teach-back' method and receive instruction in using the telemonitoring equipment. Following hospital discharge, they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a centralized call center. The nurses also will call patients and patients' physicians in response to alerts generated by the telemonitoring system, based on predetermined parameters. The primary outcome is readmission for any cause within 180 days. Secondary outcomes include 30-day readmission, mortality, hospital days, emergency department (ED) visits, hospital cost, and health-related quality of life. BEAT-HF is one of the largest randomized controlled trials of telemonitoring in patients with heart failure, and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring. The study population also includes patients with a wide range of demographic and socioeconomic characteristics. Once completed, the study will be a rich resource of information on how best to use remote technology in the care management of patients with chronic heart failure.Trial registration: # NCT01360203.
    Trials 04/2014; 15(1):124. DOI:10.1186/1745-6215-15-124 · 1.73 Impact Factor
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    • "A Cochrane Review has demonstrated that TeleMonitoring / TeleHealth is associated with significant decrease in mortality and hospital admissions / length of stay, in heart failure [18]. However, more recent experiences from randomized studies with monitoring of patients with heart failure have not translated into reduced morbidity [19] [20], reflecting the need to assess and design studies appropriately. In healthcare, the need for person to person communication can either increase the burden on health services or, alternatively, it can provide the possibility for developing less resource-intensive models of care. "

    09/2013; 1(1):132. DOI:10.5750/ejpch.v1i1.644
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