Article

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: 54.42). 11/2010; 363(24):2301-9. DOI: 10.1056/NEJMoa1010029
Source: PubMed

ABSTRACT 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; ClinicalTrials.gov number, NCT00303212.).

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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: ClinicalTrials.gov # NCT01360203.
    Trials 04/2014; 15(1):124. DOI:10.1186/1745-6215-15-124 · 2.12 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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    • "The intervention aims to activate patients by promoting self-management of HF and depression through home telemonitoring and education, and when indicated, through integrating depression care into chronic illness care [10]. While telemonitoring in isolation is not effective in improving mortality or hospitalization, [11] telemonitoring might be a useful adjunct to the collaborative care model of health care delivery. "
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    ABSTRACT: Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status.Methods/design: Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality. The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an 'effectiveness trial' to support broader implementation in the healthcare system if it is successful.Trial registration: Unique identifier: NCT00461513.
    BMC Cardiovascular Disorders 07/2013; 13(1):49. DOI:10.1186/1471-2261-13-49 · 1.50 Impact Factor
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