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: 55.87). 11/2010; 363(24):2301-9. DOI: 10.1056/NEJMoa1010029
Source: PubMed

ABSTRACT

BACKGROUND Small studies suggest that telemonitoring may improve heart-failure outcomes, but its effect in a large trial has not been established. METHODS 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. RESULTS 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. CONCLUSIONS 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.

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    • "Furthermore, patients experience a high level of satisfaction with telemonitoring and have the feeling that care-givers continuously monitor the transmitted parameters (despite the knowledge that monitoring by care-givers is non-continuously) [13]. On a population level, results regarding reduction in hospitalization and mortality rates by the use of telemonitoring in HF patients compared to usual care are ambiguous [14] [15] [16] [17] [18] [19]. It is suggested that the development of tools to automatically analyze the data and provide advice to patients and caregivers regarding the treatment of the patient would be a revolution [18]. "
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    ABSTRACT: Aim: It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. Methods: A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). Results: In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01). Conclusion: ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs.
    Full-text · Article · Oct 2015 · International Journal of Medical Informatics
    • "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.
    No preview · Conference Paper · Sep 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: ClinicalTrials.gov # NCT01360203.
    Full-text · Article · Apr 2014 · Trials
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