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Conway A, Inglis SC, Clark RA. Effective technologies for noninvasive remote monitoring in heart failure. Telemed J E Health 2014; 20:531-8. [PMID: 24731212 DOI: 10.1089/tmj.2013.0267] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Trials of new technologies to remotely monitor for signs and symptoms of worsening heart failure are continually emerging. The extent to which technological differences impact the effectiveness of noninvasive remote monitoring for heart failure management is unknown. This study examined the effect of specific technology used for noninvasive remote monitoring of people with heart failure on all-cause mortality and heart failure-related hospitalizations. MATERIALS AND METHODS A subanalysis of a large systematic review and meta-analysis was conducted. Studies were stratified according to the specific type of technology used, and separate meta-analyses were performed. Four different types of noninvasive remote monitoring technologies were identified, including structured telephone calls, videophone, interactive voice response devices, and telemonitoring. RESULTS Only structured telephone calls and telemonitoring were effective in reducing the risk of all-cause mortality (relative risk [RR]=0.87; 95% confidence interval [CI], 0.75-1.01; p=0.06; and RR=0.62; 95% CI, 0.50-0.77; p<0.0001, respectively) and heart failure-related hospitalizations (RR=0.77; 95% CI, 0.68-0.87; p<0.001; and RR=0.75; 95% CI, 0.63-0.91; p=0.003, respectively). More research data are required for videophone and interactive voice response technologies. CONCLUSIONS This subanalysis identified that only two of the four specific technologies used for noninvasive remote monitoring in heart failure improved outcomes. When results of studies that involved these disparate technologies were combined in previous meta-analyses, significant improvements in outcomes were identified. As such, this study has highlighted implications for future meta-analyses of randomized controlled trials focused on evaluating the effectiveness of remote monitoring in heart failure.
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Affiliation(s)
- Aaron Conway
- 1 School of Nursing, Queensland University Technology , Kelvin Grove, Queensland, Australia
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152
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Black JT, Romano PS, Sadeghi B, Auerbach AD, Ganiats TG, Greenfield S, Kaplan SH, Ong MK. A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition - Heart Failure (BEAT-HF) randomized controlled trial. Trials 2014; 15:124. [PMID: 24725308 PMCID: PMC3990010 DOI: 10.1186/1745-6215-15-124] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/19/2014] [Indexed: 12/24/2022] Open
Abstract
Background 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. Methods/Design 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. Discussion 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.
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Affiliation(s)
- Jeanne T Black
- Resource and Outcomes Management Department, Cedars-Sinai Health System, Los Angeles, CA 90048, USA.
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153
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Inglis SC, Conway A, Cleland JG, Clark RA. Is age a factor in the success or failure of remote monitoring in heart failure? Telemonitoring and structured telephone support in elderly heart failure patients. Eur J Cardiovasc Nurs 2014; 14:248-55. [PMID: 24681423 DOI: 10.1177/1474515114530611] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/14/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND There are few data regarding the effectiveness of remote monitoring for older people with heart failure. We conducted a post-hoc sub-analysis of a previously published large Cochrane systematic review and meta-analysis of relevant randomized controlled trials to determine whether structured telephone support and telemonitoring were effective in this population. METHODS A post hoc sub-analysis of a systematic review and meta-analysis that applied the Cochrane methodology was conducted. Meta-analyses of all-cause mortality, all-cause hospitalizations and heart failure-related hospitalizations were performed for studies where the mean or median age of participants was 70 or more years. RESULTS The mean or median age of participants was 70 or more years in eight of the 16 (n=2659/5613; 47%) structured telephone support studies and four of the 11 (n=894/2710; 33%) telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-1.00) and telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99). CONCLUSION Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the randomized controlled trials, older people with heart failure did benefit from structured telephone support and telemonitoring. These post-hoc sub-analysis results were similar to overall effects observed in the main meta-analysis. While further research is required to confirm these observational findings, the evidence at hand indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure.
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154
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Liu X, Zhong C, Zhao P, Zhang Z, Jia N, Su S, Zou B, Song Y. Analysis of therapeutic effect and safety of target-dose metoprolol in the treatment of patients with diabetes mellitus with chronic heart failure. Pak J Med Sci 2014; 30:7-11. [PMID: 24639821 PMCID: PMC3955532 DOI: 10.12669/pjms.301.3908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: To explore the therapeutic effect and safety of target-dose metoprolol in treating chronic heart failure (CHF) patients complicated with diabetes mellitus (DM). Methods: One hundred and fifty-four elderly patients were randomly divided into an observation group and a control group (n=77), which were treated with target-dose metoprolol and conventional therapy, and routinely treated respectively. The New York Heart Association (NYHA) classification, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), 6-min walking distance and medication safety of the two groups were compared. Results: Compared with the results before treatment, the NYHA classification, LVESD, LVEDD, LVEF and 6-minutes walking distance of both groups were significantly improved (P<0.05), with significantly better results in the observation group than those in the control group after treatment (P<0.05). In the 6 months of follow-up, the incidence of cardiac events in the observation group (3.90%) was significantly lower than that of the control group (14.29%) (P<0.05). The levels of average fasting blood sugar and glycosylated hemoglobin in the groups showed no significant differences (P>0.05). Conclusion: Treating CHF patients complicated with DM with target-dose metoprolol can obviously boost the cardiac function and exercise tolerance, leading to satisfactory clinical therapeutic effect, high security and moderate tolerance.
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Affiliation(s)
- Xuyang Liu
- Xuyang Liu, Department of Endocrinology, 252 Hospital of PLA, Baoding 071000, P. R. China
| | - Chengfu Zhong
- Chengfu Zhong, Department of Endocrinology, 252 Hospital of PLA, Baoding 071000, P. R. China
| | - Pengtai Zhao
- Pengtai Zhao, Department of Endocrinology, 252 Hospital of PLA, Baoding 071000, P. R. China
| | - Zhihua Zhang
- Zhihua Zhang, Department of Endocrinology, 252 Hospital of PLA, Baoding 071000, P. R. China
| | - Ning Jia
- Ning Jia, Department of Endocrinology, 252 Hospital of PLA, Baoding 071000, P. R. China
| | - Sheng'ou Su
- Sheng'ou Su, Department of Endocrinology, Second Hospital of Hebei Medical University, Shijiazhuang 050000, P. R. China
| | - Benliang Zou
- Benliang Zou, Department of Endocrinology, Xiyuan Hospital CACMS, Beijing 010000, P. R. China
| | - Yuming Song
- Yuming Song, Department of Traditional Chinese Medicine, First Center Hospital of Baoding, Baoding 071000, P. R. China
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155
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Boyne JJJ, Vrijhoef HJM. Implementing telemonitoring in heart failure care: barriers from the perspectives of patients, healthcare professionals and healthcare organizations. Curr Heart Fail Rep 2014; 10:254-61. [PMID: 23666901 DOI: 10.1007/s11897-013-0140-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various reasons. This article provides an overview of the barriers for the implementation of telemonitoring in heart failure patients from the perspectives of its users: patients, healthcare professionals and healthcare organisations. In doing so, identified barriers are grouped according to the perceived attributes of innovation by Rogers. Recommendations are provided as to how research can improve the implementation of telemonitoring in heart failure.
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Affiliation(s)
- Josiane J J Boyne
- Department of Health Services Research, Maastricht University Medical Center, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
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156
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Vest J, Kern L, Campion T, Silver M, Kaushal R. Association between use of a health information exchange system and hospital admissions. Appl Clin Inform 2014; 5:219-31. [PMID: 24734135 PMCID: PMC3974257 DOI: 10.4338/aci-2013-10-ra-0083] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/13/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Relevant patient information is frequently difficult to obtain in emergency department (ED) visits. Improved provider access to previously inaccessible patient information may improve the quality of care and reduce hospital admissions. Health information exchange (HIE) systems enable access to longitudinal, community-wide patient information at the point of care. However, the ability of HIE to avert admissions is not well demonstrated. We sought to determine if HIE system usage is correlated with a reduction in admissions via the ED. METHODS We identified 15,645 adults from New York State with an ED visit during a 6-month period, all of whom consented to have their information accessible in the HIE system, and were continuously enrolled in two area health plans. Using claims we determined if the ED encounter resulted in an admission. We used the HIE's system log files to determine usage during the encounter. We determined the association between HIE system use and the likelihood of admission to the hospital from the ED and potential cost savings. RESULTS The HIE system was accessed during 2.4% of encounters. The odds of an admission were 30% lower when the system was accessed after controlling for confounding (odds ratio = 0.70; 95%C I= 0.52, 0.95). The annual savings in the sample was $357,000. CONCLUSION These findings suggest that the use of an HIE system may reduce hospitalizations from the ED with resultant cost savings. This is an important outcome given the substantial financial investment in interventions designed to improve provider access to patient information in the US.
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Affiliation(s)
- J.R. Vest
- Joshua R Vest, Center for Healthcare Informatics & Policy, Weill Cornell Medical College, 425 East 61st Street, Suite 304, New York, NY 10062, USA, E-mail:
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157
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Purcell R, McInnes S, Halcomb EJ. Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews. BMC FAMILY PRACTICE 2014; 15:43. [PMID: 24606887 PMCID: PMC3984731 DOI: 10.1186/1471-2296-15-43] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/07/2014] [Indexed: 01/05/2023]
Abstract
Background There has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems. A number of randomised trials have been undertaken internationally and synthesised into various systematic reviews to establish an evidence base for this model of care. This study sought to synthesise and critically evaluate this large body of evidence to inform clinicians, researchers and policy makers. Methods A systematic review of systematic reviews investigating the impact of telemonitoring interventions in the primary care management of CVD was conducted. Reviews were included if they explored primary care based telemonitoring in either CVD, heart failure or hypertension, were reported in the English language and were published between 2000 and 2013. Data was extracted by one reviewer and checked by a second reviewer using a standardised form. Two assessors then rated the quality of each review using the Overview Quality Assessment Questionnaire (OQAQ). Results Of the 13 included reviews, four focused on telemonitoring interventions in hypertension or CVD management and the remaining 9 reviews investigated telemonitoring in HF management. Seven reviews scored a five or above on the OQAQ evidencing good quality reviews. Findings suggest that telemonitoring can contribute to significant reductions in blood pressure, decreased all-cause and HF related hospitalisations, reduced all-cause mortality and improved quality of life. Telemonitoring was also demonstrated to reduce health care costs and appears acceptable to patients. Conclusion Telemonitoring has the potential to enhance primary care management of CVD by improving patient outcomes and reducing health costs. However, further research needs to explore the specific elements of telemonitoring interventions to determine the relative value of the various elements. Additionally, the ways in which telemonitoring care improves health outcomes needs to be further explored to understand the nature of these interventions.
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Affiliation(s)
| | | | - Elizabeth J Halcomb
- School of Nursing & Midwifery, University of Wollongong, Wollongong, NSW, Australia.
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158
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Inglis SC, Clark RA, McAlister FA, Stewart S, Cleland JG. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Coc. Eur J Heart Fail 2014; 13:1028-40. [PMID: 21733889 DOI: 10.1093/eurjhf/hfr039] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sally C. Inglis
- Preventative Health, Baker IDI Heart and Diabetes Institute and Faculty of Nursing, Midwifery and Health; University of Technology; Sydney Australia
| | - Robyn A. Clark
- School of Nursing and Midwifery; Queensland University of Technology; Queensland Australia
| | - Finlay A. McAlister
- Division of General Internal Medicine; University of Alberta; Edmonton Canada
| | - Simon Stewart
- Preventative Health, Baker IDI Heart and Diabetes Institute and Faculty of Nursing, Midwifery and Health; University of Technology; Sydney Australia
| | - John G.F. Cleland
- Academic Unit of Cardiology; Castle Hill Hospital; East Yorkshire UK
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159
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Hall AK, Dodd V, Harris A, McArthur K, Dacso C, Colton LM. Heart failure patients' perceptions and use of technology to manage disease symptoms. Telemed J E Health 2014; 20:324-31. [PMID: 24483939 DOI: 10.1089/tmj.2013.0146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Technology use for symptom management is beneficial for both patients and physicians. Widespread acceptance of technology use in healthcare fuels continued development of technology with ever-increasing sophistication. Although acceptance of technology use in healthcare by medical professionals is evident, less is known about the perceptions, preferences, and use of technology by heart failure (HF) patients. This study explores patients' perceptions and current use of technology for managing HF symptoms (MHFS). MATERIALS AND METHODS A qualitative analysis of in-depth individual interviews using a constant comparative approach for emerging themes was conducted. Fifteen participants (mean age, 64.43 years) with HF were recruited from hospitals, cardiology clinics, and community groups. RESULTS All study participants reported use of a home monitoring device, such as an ambulatory blood pressure device or bathroom scale. The majority of participants reported not accessing online resources for additional MHFS information. However, several participants stated their belief that technology would be useful for MHFS. Participants reported increased access to care, earlier indication of a worsening condition, increased knowledge, and greater convenience as potential benefits of technology use while managing HF symptoms. For most participants financial cost, access issues, satisfaction with current self-care routine, mistrust of technology, and reliance on routine management by their current healthcare provider precluded their use of technology for MHFS. CONCLUSIONS Knowledge about HF patients' perceptions of technology use for self-care and better understanding of issues associated with technology access can aid in the development of effective health behavior interventions for individuals who are MHFS and may result in increased compliance, better outcomes, and lower healthcare costs.
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Affiliation(s)
- Amanda K Hall
- 1 Center for Digital Health and Wellness, Department of Health Education and Behavior, College of Health and Human Performance, University of Florida , Gainesville, Florida
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160
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Jones CD, Holmes GM, DeWalt DA, Erman B, Wu JR, Cene CW, Baker DW, Schillinger D, Ruo B, Bibbins-Domingo K, Macabasco-O'Connell A, Hawk V, Broucksou K, Pignone M. Self-reported recall and daily diary-recorded measures of weight monitoring adherence: associations with heart failure-related hospitalization. BMC Cardiovasc Disord 2014; 14:12. [PMID: 24483776 PMCID: PMC3912256 DOI: 10.1186/1471-2261-14-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 01/08/2014] [Indexed: 01/10/2023] Open
Abstract
Background Weight monitoring is an important element of HF self-care, yet the most clinically meaningful way to evaluate weight monitoring adherence is uncertain. We conducted this study to evaluate the association of (1) self-reported recall and (2) daily diary-recorded weight monitoring adherence with heart failure-related (HF-related) hospitalization. Methods We conducted a prospective cohort study among 216 patients within a randomized trial of HF self-care training. All patients had an initial self-care training session followed by 15 calls (median) to reinforce educational material; patients were also given digital scales, instructed to weigh daily, record weights in a diary, and mail diaries back monthly. Weight monitoring adherence was assessed with a self-reported recall question administered at 12 months and dichotomized into at least daily versus less frequent weighing. Diary-recorded weight monitoring was evaluated over 12 months and dichotomized into ≥80% and <80% adherence. HF-related hospitalizations were ascertained through patient report and confirmed through record review. Results Over 12 months in 216 patients, we identified 50 HF-related hospitalizations. Patients self-reporting daily or more frequent weight monitoring had an incidence rate ratio of 1.34 (95% CI 0.24-7.32) for HF-related hospitalizations compared to those reporting less frequent weight monitoring. Patients who completed ≥80% of weight diaries had an IRR of 0.37 (95% CI 0.18-0.75) for HF-related hospitalizations compared to patients who completed <80% of weight diaries. Conclusions Self-reported recall of weight monitoring adherence was not associated with fewer HF hospitalizations. In contrast, diary-recorded adherence ≥80% of days was associated with fewer HF-related hospitalizations. Incorporating diary-based measures of weight monitoring adherence into HF self-care training programs may help to identify patients at risk for HF-related hospitalizations.
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Affiliation(s)
- Christine D Jones
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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161
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Nolan RP, Payne AY, Ross H, White M, D'Antono B, Chan S, Barr SI, Gwadry-Sridhar F, Nigam A, Perreault S, Farkouh M, McDonald M, Goodman J, Thomas S, Zieroth S, Isaac D, Oh P, Rajda M, Chen M, Eysenbach G, Liu S, Zbib A. An Internet-Based Counseling Intervention With Email Reminders that Promotes Self-Care in Adults With Chronic Heart Failure: Randomized Controlled Trial Protocol. JMIR Res Protoc 2014; 3:e5. [PMID: 24480783 PMCID: PMC3936276 DOI: 10.2196/resprot.2957] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 01/03/2023] Open
Abstract
Background Chronic heart failure (CHF) is a public health priority. Its age-standardized prevalence has increased over the past decade. A major challenge for the management of CHF is to promote long-term adherence to self-care behaviors without overtaxing available health care resources. Counseling by multidisciplinary health care teams helps to improve adherence to self-care behaviors and to reduce the rate of death and hospitalization. In the absence of intervention, adherence to self-care is below recommended standards. Objective This trial aims to establish and evaluate a Canadian e-platform that will provide a core, standardized protocol of behavioral counseling and education to facilitate long-term adherence to self-care among patients with CHF. Methods Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) is a multi-site, double blind, randomized controlled trial with a 2 parallel-group (e-Counseling + Usual Care vs e-Info Control + Usual Care) by 3 assessments (baseline, 4-, and 12-month) design. We will identify subjects with New York Heart Association Class II or III systolic heart failure from collaborating CHF clinics and then recruit them (n=278) by phone. Subjects will be randomized in blocks within each site (Toronto, Montreal, and Vancouver). The primary outcome will be improved quality of life, defined as an increased number of subjects with an improvement of ≥5 points on the summary score of the Kansas City Cardiomyopathy Questionnaire. We will also assess the following secondary outcomes: (1) diet habits, depression, anxiety, smoking history, stress level, and readiness for change using self-report questionnaires, (2) physical activity level, current smoking status, and vagal-heart rate modulation by physiological tests, and (3) exercise capacity, prognostic indicators of cardiovascular functioning, and medication adherence through medical chart review. The primary outcome will be analyzed using generalized estimation equations with repeated measures on an intention-to-treat basis. Secondary outcomes will be analyzed using repeated-measures linear mixed models with a random effects intercept. All significant main effects or interactions in the statistical models will be followed up with post hoc contrasts using a Bonferroni correction with a 2-sided statistical significance criterion of P<.05. Results This 3.5-year, proof-of-principle trial will establish the e-infrastructure for a pan-Canadian e-platform for CHF that is comprised of a standardized, evidence-based protocol of e-Counseling. Conclusions CHF-CePPORT is designed to improve long-term adherence to self-care behaviors and quality of life among patients with CHF. It will demonstrate a distinct Canadian initiative to build capacity for preventive eHealth services for patients with CHF. Trial Registration ClinicalTrials.gov NCT01864369; http://clinicaltrials.gov/ct2/show/NCT01864369 (Archived by WebCite at http://www.webcitation.org/6Iiv6so7E).
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Affiliation(s)
- Robert P Nolan
- Behavioral Cardiology Research Unit, University Health Network, Toronto, ON, Canada.
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162
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Dingli A, Seychell D. Using RFID and Wi-Fi in Healthcare. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2014. [DOI: 10.4018/ijehmc.2014010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Europe faces a considerable challenge in providing good quality health care in the forthcoming future as the aging population increases. The phenomenon also results in a considerable cost on society due to the dependency on the public health sector particularly because such individuals would not be able to contribute to the economy. On the other hand, younger persons would need to make alternative arrangements to assist their elderly parents or relatives, potentially affecting productivity. The project PervasIve Nursing And docToral Assistant (PINATA) seeks to tackle this matter through the merging of Ambient Intelligence (AmI) and semantic web technologies. PINATA utilises pervasive devices to aid doctors and nurses to focus on the patient and thus improve the quality of healthcare services. This project proves the significant importance of using wireless technology in healthcare. This paper focuses on the use of Wi-Fi and RFID in an effort to enable continuous and intelligent monitoring of patients' conditions remotely. Results show that the detection system performs well (over 80%) accuracy on fall detection and the manual readings mapped 100% with the results collected by the system over the Wi-Fi infrastructure discussed in this paper.
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Affiliation(s)
- Alexiei Dingli
- Department of Intelligent Computer Systems, Faculty of ICT, University of Malta, Msida, Malta
| | - Dylan Seychell
- Department of Computing and Information Systems, St Martin's Institute of Higher Education, Malta
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163
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Madigan E, Schmotzer BJ, Struk CJ, DiCarlo CM, Kikano G, Piña IL, Boxer RS. Home health care with telemonitoring improves health status for older adults with heart failure. Home Health Care Serv Q 2013; 32:57-74. [PMID: 23438509 DOI: 10.1080/01621424.2012.755144] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status.
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Affiliation(s)
- Elizabeth Madigan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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164
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Small N, Blickem C, Blakeman T, Panagioti M, Chew-Graham CA, Bower P. Telephone based self-management support by 'lay health workers' and 'peer support workers' to prevent and manage vascular diseases: a systematic review and meta-analysis. BMC Health Serv Res 2013; 13:533. [PMID: 24370214 PMCID: PMC3880982 DOI: 10.1186/1472-6963-13-533] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 12/10/2013] [Indexed: 11/13/2022] Open
Abstract
Background Improved prevention and management of vascular disease is a global priority. Non-health care professionals (such as, ‘lay health workers’ and ‘peer support workers’) are increasingly being used to offer telephone support alongside that offered by conventional services, to reach disadvantaged populations and to provide more efficient delivery of care. However, questions remain over the impact of such interventions, particularly on a wider range of vascular related conditions (such as, chronic kidney disease), and it is unclear how different types of telephone support impact on outcome. This study assessed the evidence on the effectiveness and cost-effectiveness of telephone self-management interventions led by ‘lay health workers’ and ‘peer support workers’ for patients with vascular disease and long-term conditions associated with vascular disease. Methods Systematic review of randomised controlled trials. Three electronic databases were searched. Two authors independently extracted data according to the Cochrane risk of bias tool. Random effects meta-analysis was used to pool outcome measures. Results Ten studies were included, primarily based in community settings in the United States; with participants who had diabetes; and used ‘peer support workers’ that shared characteristics with patients. The included studies were generally rated at risk of bias, as many methodological criteria were rated as ‘unclear’ because of a lack of information. Overall, peer telephone support was associated with small but significant improvements in self-management behaviour (SMD = 0.19, 95% CI 0.05 to 0.33, I2 = 20.4%) and significant reductions in HbA1c level (SMD = -0.26, 95% CI −0.41 to −0.11, I2 = 47.6%). There was no significant effect on mental health quality of life (SMD = 0.03, 95% CI −0.12 to 0.18, I2 = 0%). Data on health care utilisation were very limited and no studies reported cost effectiveness analyses. Conclusions Positive effects were found for telephone self-management interventions via ‘lay workers’ and ‘peer support workers’ for patients on diabetes control and self-management outcomes, but the overall evidence base was limited in scope and quality. Well designed trials assessing non-healthcare professional delivered telephone support for the prevention and management of vascular disease are needed to identify the content of effective components on health outcomes, and to assess cost effectiveness, to determine if such interventions are potentially useful alternatives to professionally delivered care.
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Affiliation(s)
- Nicola Small
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Centre for Primary Care, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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165
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Iyngkaran P, Harris M, Ilton M, Kangaharan N, Battersby M, Stewart S, Brown A. Implementing guideline based heart failure care in the Northern Territory: challenges and solutions. Heart Lung Circ 2013; 23:391-406. [PMID: 24548637 DOI: 10.1016/j.hlc.2013.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
Abstract
The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a "health care gap". The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.
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Affiliation(s)
- Pupalan Iyngkaran
- Consultant Cardiologist, Senior Lecturer Flinders University, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Melanie Harris
- Senior Research Fellow, Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100 Adelaide SA 5001.
| | - Marcus Ilton
- Director of Cardiology, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Nadarajan Kangaharan
- Director of Medicine/Consultant Cardiologist, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, Bedford Park, South Australia, Australia 5001.
| | - Simon Stewart
- Director NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC, 3004, Australia.
| | - Alex Brown
- Professor of Population Health and Research Chair Aboriginal Health School of Population Health, University of South Australia & South Australian Health & Medical Research Institute, Adelaide.
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166
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Lyngå P, Fridlund B, Langius-Eklöf A, Bohm K. Perceptions of transmission of body weight and telemonitoring in patients with heart failure? Int J Qual Stud Health Well-being 2013; 8:21524. [PMID: 24345687 PMCID: PMC3866836 DOI: 10.3402/qhw.v8i0.21524] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 01/28/2023] Open
Abstract
Chronic heart failure (HF) is associated with a high burden of morbidity and mortality and with reduced quality of life. New techniques such as telemonitoring (TM) have recently been introduced in the care of patients with HF in order to improve outcomes. TM is defined as sending data from the patients' home to healthcare professionals. Most studies have focussed on endpoints such as morbidity and mortality, and relatively little attention has been paid to patients' perceptions of TM. Therefore, the aim of this study was to explore and describe patients' perceptions of transmission of body weight (BW) and TM, regularly accomplished from patients' homes to an HF clinic. An explorative design with a phenomenographic approach was used, and semi-structured interviews were conducted with a maximum variation sampling of 20 participants. The findings are described in five metaphoric categories that were assigned and used as a description: the habitual patient, the concerned patient, the technical patient, the secure patient, and the self-caring patient. The conclusions were that the transmission of BW made the patients active in their own care and increased self-care activities. In clinical care, concerns for deterioration in HF as well as the reliability of the TM system should be considered. Future research may focus on healthcare professionals and their perceptions of transmission of BW and TM in the care of patients with HF.
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Affiliation(s)
- Patrik Lyngå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden;
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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167
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Li YL, Ju JQ, Yang CH, Jiang HQ, Xu JW, Zhang SJ. Oral Chinese herbal medicine for improvement of quality of life in patients with chronic heart failure: a systematic review and meta-analysis. Qual Life Res 2013; 23:1177-92. [PMID: 24258255 DOI: 10.1007/s11136-013-0582-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Chronic heart failure (CHF) is not only a leading cause of death, hospitalization, and rehospitalization, but also significantly decreases quality of life (QoL). This study aims to evaluate published clinical trials of oral Chinese herbal medicine (OCHM) for improvement of QoL in patients with CHF that employ the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score as an outcome measure. METHODS A systematic literature search was performed using five databases up to June 2013 to identify randomized control trials (RCTs). RCTs involving OCHM plus conventional medicine treatment (CMT) with or without blinding, compared with CMT with or without placebo, with MLHFQ score as an outcome measure were identified. The methodological quality of RCTs was assessed independently using the Cochrane Handbook for Systematic Review of Interventions. RevMan 5.2.5 and Stata 11.0 were used for data analysis. RESULTS Thirty-eight RCTs with a total of 3,170 participants were identified. The majority of the included trials were assessed to be of high clinical heterogeneity and poor methodological quality. The main results of meta-analysis showed improvement of total MLHFQ score when OCHM plus CMT compared with CMT with or without placebo [MD = -5.71 (-7.07, -4.36), p < 0.01]. CONCLUSIONS There is some encouraging evidence of OCHM combined with CMT for the improvement of QoL in CHF patients. However, the evidence remains weak due to the small sample size, high clinical heterogeneity, and poor methodological quality of the included trials. Further, large sample size and well-designed trials are needed.
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Affiliation(s)
- Yun-Lun Li
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42, Cultural West Road, Jinan, 250011, Shandong, People's Republic of China,
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168
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Abstract
"The Teledactyl (Tele, far; Dactyl, finger--from the Greek) is a future instrument by which it will be possible for us to 'feel at a distance.' This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance...The doctor manipulates his controls, which are then manipulated at the patient's room in exactly the same manner. The doctor sees what is going on in the patient's room by means of a television screen." -Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor.
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Affiliation(s)
- Arvind Bhimaraj
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA
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169
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Thokala P, Baalbaki H, Brennan A, Pandor A, Stevens JW, Gomersall T, Wang J, Bakhai A, Al-Mohammad A, Cleland J, Cowie MR, Wong R. Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs. BMJ Open 2013; 3:e003250. [PMID: 24048626 PMCID: PMC3780300 DOI: 10.1136/bmjopen-2013-003250] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 07/10/2013] [Accepted: 07/30/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness of remote monitoring strategies versus usual care for adults recently discharged after a heart failure (HF) exacerbation. DESIGN Decision analysis modelling of cost-effectiveness using secondary data sources. SETTING Acute hospitals in the UK. PATIENTS Patients recently discharged (within 28 days) after a HF exacerbation. INTERVENTIONS Structured telephone support (STS) via human to machine (STS HM) interface, (2) STS via human to human (STS HH) contact and (3) home telemonitoring (TM), compared with (4) usual care. MAIN OUTCOME MEASURES The incremental cost per quality-adjusted life year (QALY) gained by each strategy compared to the next most effective alternative and the probability of each strategy being cost-effective at varying willingness to pay per QALY gained. RESULTS TM was the most cost-effective strategy in the scenario using these base case costs. Compared with usual care, TM had an estimated incremental cost effectiveness ratio (ICER) of £11 873/QALY, whereas STS HH had an ICER of £228 035/QALY against TM. STS HM was dominated by usual care. Threshold analysis suggested that the monthly cost of TM has to be higher than £390 to have an ICER greater than £20 000/QALY against STS HH. Scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM do not substantially change the conclusions. CONCLUSIONS Cost-effectiveness analyses suggest that TM was an optimal strategy in most scenarios, but there is considerable uncertainty in relation to clear descriptions of the interventions and robust estimation of costs.
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Affiliation(s)
| | | | | | | | | | | | - Jenny Wang
- ScHARR, University of Sheffield, Sheffield, UK
| | - Ameet Bakhai
- Department of Cardiology, Barnet and Chase Farm Hospitals NHS Trust, Enfield, UK
| | - Abdallah Al-Mohammad
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Cleland
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, UK
| | - Martin R Cowie
- National Heart & Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK
| | - Ruth Wong
- ScHARR, University of Sheffield, Sheffield, UK
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170
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McLean S, Sheikh A, Cresswell K, Nurmatov U, Mukherjee M, Hemmi A, Pagliari C. The impact of telehealthcare on the quality and safety of care: a systematic overview. PLoS One 2013; 8:e71238. [PMID: 23977001 PMCID: PMC3747134 DOI: 10.1371/journal.pone.0071238] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/27/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Telehealthcare involves the use of information and communication technologies to deliver healthcare at a distance and to support patient self-management through remote monitoring and personalised feedback. It is timely to scrutinise the evidence regarding the benefits, risks and costs of telehealthcare. METHODS AND FINDINGS Two reviewers searched for relevant systematic reviews published from January 1997 to November 2011 in: The Cochrane Library, MEDLINE, EMBASE, LILACS, IndMed and PakMed. Reviewers undertook independent quality assessment of studies using the Critical Appraisal Skills Programme (CASP) tool for systematic reviews. 1,782 review articles were identified, from which 80 systematic reviews were selected for inclusion. These covered a range of telehealthcare models involving both synchronous (live) and asynchronous (store-and-forward) interactions between provider and patients. Many studies showed no differences in outcomes between telehealthcare and usual care. Several reviews highlighted the large number of short-term (<12 months) feasibility studies with under 20 participants. Effects of telehealthcare on health service indicators were reported in several reviews, particularly reduced hospitalisations. The reported clinical effectiveness of telehealthcare interventions for patients with long-term conditions appeared to be greatest in those with more severe disease at high-risk of hospitalisation and death. The failure of many studies to adequately describe the intervention makes it difficult to disentangle the contributions of technological and human/organisational factors on the outcomes reported. Evidence on the cost-effectiveness of telehealthcare remains sparse. Patient safety considerations were absent from the evaluative telehealthcare literature. CONCLUSIONS Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.
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Affiliation(s)
- Susannah McLean
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kathrin Cresswell
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ulugbek Nurmatov
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Mome Mukherjee
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Akiko Hemmi
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Claudia Pagliari
- eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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171
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Nicklas JM, Bleske BE, Van Harrison R, Hogikyan RV, Kwok Y, Chavey WE. Heart failure: clinical problem and management issues. Prim Care 2013; 40:17-42. [PMID: 23402460 DOI: 10.1016/j.pop.2012.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Heart failure (HF) often presents as dyspnea either with exertion and/or recumbency. Patients also experience dependent swelling and fatigue. Measurement of the left ventricular ejection fraction (LVEF) identifies HF patients who may respond to pharmacologic therapy and/or electrophysiologic device implantation. Angiotension converting enzyme inhibitors, beta blockers, and aldosterone inhibitors can significantly lower the mortality and morbidity of HF in patients with an LVEF less than 35%. Cardiac defibrillators and biventricular pacemakers can also improve outcomes in selected patients with a decreased LVEF. The authors provide a guide for therapeutic decisions based on the inclusion criteria of the major clinical trials.
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Affiliation(s)
- John M Nicklas
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1600 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
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172
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Freitas MTSD, Püschel VDAA. Insuficiência cardíaca: expressões do conhecimento das pessoas sobre a doença. Rev Esc Enferm USP 2013; 47:922-30. [DOI: 10.1590/s0080-623420130000400021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 12/18/2012] [Indexed: 01/25/2023] Open
Abstract
Pesquisa de natureza qualitativa que teve como objetivos caracterizar pessoas com Insuficiência Cardíaca (IC) segundo perfil sócio-demográfico, de saúde e de tratamento e analisar o conhecimento sobre a doença e tratamento. Foram entrevistados 42 pacientes com IC, em um hospital de cardiologia de São Paulo, foi utilizado questionário semiestruturado e análise de conteúdo dos dados. Predominou sexo masculino, idade maior que 45 anos, classe funcional II, comorbidades associadas e tratamento farmacológico. Da análise de conteúdo emergiram as categorias: conhecimento sobre a doença e conhecimento do tratamento. O conhecimento é ilustrativo, diagnóstico e explicativo, sendo atribuídos muitos significados à doença. A maioria desconhece nome, dose e frequência de uso dos medicamentos. O tratamento não farmacológico está relacionado às orientações dos profissionais de saúde sobre alimentação, sal e ingesta hídrica. Os resultados abrem perspectivas para intervenções educativas sistematizadas que possam contribuir para um melhor enfrentamento e manejo da doença.
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173
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Prescher S, Bourke AK, Koehler F, Martins A, Sereno Ferreira H, Boldt Sousa T, Castro RN, Santos A, Torrent M, Gomis S, Hospedales M, Nelson J. Ubiquitous ambient assisted living solution to promote safer independent living in older adults suffering from co-morbidity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:5118-21. [PMID: 23367080 DOI: 10.1109/embc.2012.6347145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper describes the development, deployment and trial results from 9 volunteers using the eCAALYX system. The eCAALYX system is an ambient assisted living telemonitoring system aimed at older adults suffering with co-morbidity. Described is a raw account of the challenges that exist and results in bringing a Telemedicine system from laboratory to real-world implementation and results for usability, functionality and reliability.
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174
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Kitsiou S, Paré G, Jaana M. Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases: a critical assessment of their methodological quality. J Med Internet Res 2013; 15:e150. [PMID: 23880072 PMCID: PMC3785977 DOI: 10.2196/jmir.2770] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases have increased over the past decade and become increasingly important to a wide range of clinicians, policy makers, and other health care stakeholders. While a few criticisms about their methodological rigor and synthesis approaches have recently appeared, no formal appraisal of their quality has been conducted yet. OBJECTIVE The primary aim of this critical review was to evaluate the methodology, quality, and reporting characteristics of prior reviews that have investigated the effects of home telemonitoring interventions in the context of chronic diseases. METHODS Ovid MEDLINE, the Database of Abstract of Reviews of Effects (DARE), and Health Technology Assessment Database (HTA) of the Cochrane Library were electronically searched to find relevant systematic reviews, published between January 1966 and December 2012. Potential reviews were screened and assessed for inclusion independently by three reviewers. Data pertaining to the methods used were extracted from each included review and examined for accuracy by two reviewers. A validated quality assessment instrument, R-AMSTAR, was used as a framework to guide the assessment process. RESULTS Twenty-four reviews, nine of which were meta-analyses, were identified from more than 200 citations. The bibliographic search revealed that the number of published reviews has increased substantially over the years in this area and although most reviews focus on studying the effects of home telemonitoring on patients with congestive heart failure, researcher interest has extended to other chronic diseases as well, such as diabetes, hypertension, chronic obstructive pulmonary disease, and asthma. Nevertheless, an important number of these reviews appear to lack optimal scientific rigor due to intrinsic methodological issues. Also, the overall quality of reviews does not appear to have improved over time. While several criteria were met satisfactorily by either all or nearly all reviews, such as the establishment of an a priori design with inclusion and exclusion criteria, use of electronic searches on multiple databases, and reporting of studies characteristics, there were other important areas that needed improvement. Duplicate data extraction, manual searches of highly relevant journals, inclusion of gray and non-English literature, assessment of the methodological quality of included studies and quality of evidence were key methodological procedures that were performed infrequently. Furthermore, certain methodological limitations identified in the synthesis of study results have affected the results and conclusions of some reviews. CONCLUSIONS Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring. Further efforts should be made to improve the design, conduct, reporting, and publication of systematic reviews and meta-analyses in this area.
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Affiliation(s)
- Spyros Kitsiou
- Canada Research Chair in Information Technology in Health Care, HEC Montreal, Montreal, QC, Canada.
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175
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Brettell R, Soljak M, Cecil E, Cowie MR, Tuppin P, Majeed A. Reducing heart failure admission rates in England 2004-2011 are not related to changes in primary care quality: national observational study. Eur J Heart Fail 2013; 15:1335-42. [PMID: 23845798 PMCID: PMC3834843 DOI: 10.1093/eurjhf/hft107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Heart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission. METHODS AND RESULTS We used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004-2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality ('Quality and Outcomes Framework' indicator.) There were 327,756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100,000 in 2004 to 5.60/100,000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates. CONCLUSIONS The observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.
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Affiliation(s)
- Rachel Brettell
- Department of Primary Care Health Sciences, University of Oxford, UK
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176
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Kotooka N, Asaka M, Sato Y, Kinugasa Y, Nochioka K, Mizuno A, Nagatomo D, Mine D, Yamada Y, Eguchi K, Hanaoka H, Inomata T, Fukumoto Y, Yamamoto K, Tsutsui H, Masuyama T, Kitakaze M, Inoue T, Shimokawa H, Momomura SI, Seino Y, Node K. Home telemonitoring study for Japanese patients with heart failure (HOMES-HF): protocol for a multicentre randomised controlled trial. BMJ Open 2013; 3:e002972. [PMID: 23794546 PMCID: PMC3669725 DOI: 10.1136/bmjopen-2013-002972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 04/19/2013] [Accepted: 04/22/2013] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Despite the encouraging results from several randomised controlled trials (RCTs) and meta-analyses, the ability of home telemonitoring for heart failure (HF) to improve patient outcomes remains controversial as a consequence of the two recent large-scale RCTs. However, it has been suggested that there is a subgroup of patients with HF who may benefit from telemonitoring. The aim of the present study was to investigate whether an HF management programme using telemonitoring could improve outcomes in patients with HF under the Japanese healthcare system. METHODS AND ANALYSIS The Home Telemonitoring Study for Japanese Patients with Heart Failure (HOMES-HF) study is a prospective, multicentre RCT to investigate the effectiveness of home telemonitoring on the primary composite endpoint of all-cause death and rehospitalisation due to worsening HF in recently admitted HF patients (aged 20 and older, New York Heart Association classes II-III). The telemonitoring system is an automated physiological monitoring system including body weight, blood pressure and pulse rate by full-time nurses 7 days a week. Additionally, the system was designed to make it a high priority to support patient's self-care instead of an early detection of HF decompensation. A total sample size of 420 patients is planned according to the Schoenfeld and Richter method. Eligible patients are randomly assigned via a website to either the telemonitoring group or the usual care group by using a minimisation method with biased-coin assignment balancing on age, left ventricular ejection fraction and a history of ischaemic heart disease. Participants will be enrolled until August 2013 and followed until August 2014. Time to events will be estimated using the Kaplan-Meier method, and HRs and 95% CIs will be calculated using the Cox proportional hazards models with stratification factors. TRIAL REGISTRATION The study is registered at UMIN Clinical Trials Registry (UMIN000006839).
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Affiliation(s)
- Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Machiko Asaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yasunori Sato
- Chiba University Hospital Clinical Research Center, Chiba University, Chiba, Japan
| | - Yoshiharu Kinugasa
- Division of Cardiolovascular Medicine, Department of Molecular Medicine and Therapeutics, Tottori University, Yonago, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Nagatomo
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Daigo Mine
- Department of Cardiology, Saga Prefectural Hospital Koseikan, Saga, Japan
| | - Yoko Yamada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Omiya, Japan
| | - Kazuo Eguchi
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hideki Hanaoka
- Chiba University Hospital Clinical Research Center, Chiba University, Chiba, Japan
| | - Takayuki Inomata
- Department of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshihiro Fukumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiolovascular Medicine, Department of Molecular Medicine and Therapeutics, Tottori University, Yonago, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Omiya, Japan
| | - Yoshihiko Seino
- Department of Cardiology, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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177
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A predictive modeling approach to increasing the economic effectiveness of disease management programs. Health Care Manag Sci 2013; 17:284-301. [DOI: 10.1007/s10729-013-9246-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
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178
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:e240-327. [PMID: 23741058 DOI: 10.1161/cir.0b013e31829e8776] [Citation(s) in RCA: 1518] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
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- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
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179
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128:1810-52. [PMID: 23741057 DOI: 10.1161/cir.0b013e31829e8807] [Citation(s) in RCA: 2325] [Impact Index Per Article: 211.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Clyde W Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
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180
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Zanaboni P, Landolina M, Marzegalli M, Lunati M, Perego GB, Guenzati G, Curnis A, Valsecchi S, Borghetti F, Borghi G, Masella C. Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial. J Med Internet Res 2013; 15:e106. [PMID: 23722666 PMCID: PMC3670725 DOI: 10.2196/jmir.2587] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/25/2013] [Accepted: 05/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up. OBJECTIVE We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators. METHODS Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained. RESULTS Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. CONCLUSIONS Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations. TRIAL REGISTRATION ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Pandor A, Gomersall T, Stevens JW, Wang J, Al-Mohammad A, Bakhai A, Cleland JGF, Cowie MR, Wong R. Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis. Heart 2013; 99:1717-26. [DOI: 10.1136/heartjnl-2013-303811] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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182
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Turkstra E, Hawkes AL, Oldenburg B, Scuffham PA. Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial (ProActive Heart). BMC Cardiovasc Disord 2013; 13:33. [PMID: 23634982 PMCID: PMC3646683 DOI: 10.1186/1471-2261-13-33] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 04/18/2013] [Indexed: 11/13/2022] Open
Abstract
Background Participation in coronary heart disease (CHD) secondary prevention programs is low. Telephone-delivered CHD secondary prevention programs may overcome the treatment gap. The telephone-based health coaching ProActive Heart trial intervention has previously been shown to be effective for improving health-related quality of life, physical activity, body mass index, diet, alcohol intake and anxiety. As a secondary aim, the current study evaluated the cost-effectiveness of the ProActive Heart intervention compared to usual care. Methods 430 adult myocardial infarction patients were randomised to a six-month CHD secondary prevention ‘health coaching’ intervention or ‘usual care’ control group. Primary outcome variables were health-related quality of life (SF-36) and physical activity (Active Australia Survey). Data were collected at baseline, six-months (post-intervention) and 12 months (six-months post-intervention completion) for longer term effects. Cost-effectiveness data [health utility (SF-6D) and health care utilisation] were collected using self-reported (general practitioner, specialist, other health professionals, health services, and medication) and claims data (hospitalisation rates). Intervention effects are presented as mean differences (95% CI), p-value. Results Improvements in health status (SF-6D) were observed in both groups, with no significant difference between the groups at six [0.012 (-0.016, 0.041), p = 0.372] or 12 months [0.011 (-0.028, 0.051) p = 0.738]. Patients in the health coaching group were significantly more likely to be admitted to hospital due to causes unrelated to cardiovascular disease (p = 0.042). The overall cost for the health coaching group was higher ($10,574 vs. $8,534, p = 0.021), mainly due to higher hospitalisation (both CHD and non-CHD) costs ($6,841 vs. $4,984, p = 0.036). The incremental cost-effectiveness ratio was $85,423 per QALY. Conclusions There was no intervention effect measured using the SF-36/SF-6D and ProActive Heart resulted in significantly increased costs. The cost per QALY gained from ProActive Heart was high and above acceptable limits compared to usual care.
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183
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Assessing hospital readmission risk factors in heart failure patients enrolled in a telemonitoring program. Int J Telemed Appl 2013; 2013:305819. [PMID: 23710170 PMCID: PMC3655587 DOI: 10.1155/2013/305819] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/26/2013] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to validate a previously developed heart failure readmission predictive algorithm based on psychosocial factors, develop a new model based on patient-reported symptoms from a telemonitoring program, and assess the impact of weight fluctuations and other factors on hospital readmission. Clinical, demographic, and telemonitoring data was collected from 100 patients enrolled in the Partners Connected Cardiac Care Program between July 2008 and November 2011. 38% of study participants were readmitted to the hospital within 30 days. Ten different heart-failure-related symptoms were reported 17,389 times, with the top three contributing approximately 50% of the volume. The psychosocial readmission model yielded an AUC of 0.67, along with sensitivity 0.87, specificity 0.32, positive predictive value 0.44, and negative predictive value 0.8 at a cutoff value of 0.30. In summary, hospital readmission models based on psychosocial characteristics, standardized changes in weight, or patient-reported symptoms can be developed and validated in heart failure patients participating in an institutional telemonitoring program. However, more robust models will need to be developed that use a comprehensive set of factors in order to have a significant impact on population health.
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184
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Charness N, Fox M, Papadopoulos A, Crump C. Metrics for assessing the reliability of a telemedicine remote monitoring system. Telemed J E Health 2013; 19:487-92. [PMID: 23611640 DOI: 10.1089/tmj.2012.0143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The goal of this study was to assess using new metrics the reliability of a real-time health monitoring system in homes of older adults. MATERIALS AND METHODS The "MobileCare Monitor" system was installed into the homes of nine older adults >75 years of age for a 2-week period. The system consisted of a wireless wristwatch-based monitoring system containing sensors for location, temperature, and impacts and a "panic" button that was connected through a mesh network to third-party wireless devices (blood pressure cuff, pulse oximeter, weight scale, and a survey-administering device). To assess system reliability, daily phone calls instructed participants to conduct system tests and reminded them to fill out surveys and daily diaries. Phone reports and participant diary entries were checked against data received at a secure server. RESULTS Reliability metrics assessed overall system reliability, data concurrence, study effectiveness, and system usability. Except for the pulse oximeter, system reliability metrics varied between 73% and 92%. Data concurrence for proximal and distal readings exceeded 88%. System usability following the pulse oximeter firmware update varied between 82% and 97%. An estimate of watch-wearing adherence within the home was quite high, about 80%, although given the inability to assess watch-wearing when a participant left the house, adherence likely exceeded the 10 h/day requested time. In total, 3,436 of 3,906 potential measurements were obtained, indicating a study effectiveness of 88%. CONCLUSIONS The system was quite effective in providing accurate remote health data. The different system reliability measures identify important error sources in remote monitoring systems.
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Affiliation(s)
- Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida 32306-4301, USA.
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185
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Forest SJ, Bello R, Friedmann P, Casazza D, Nucci C, Shin JJ, D'Alessandro D, Stevens G, Goldstein DJ. Readmissions After Ventricular Assist Device: Etiologies, Patterns, and Days Out of Hospital. Ann Thorac Surg 2013; 95:1276-81. [DOI: 10.1016/j.athoracsur.2012.12.039] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 12/13/2012] [Accepted: 12/21/2012] [Indexed: 11/25/2022]
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186
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Martín-Lesende I, Orruño E, Bilbao A, Vergara I, Cairo MC, Bayón JC, Reviriego E, Romo MI, Larrañaga J, Asua J, Abad R, Recalde E. Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial). BMC Health Serv Res 2013; 13:118. [PMID: 23537332 PMCID: PMC3636109 DOI: 10.1186/1472-6963-13-118] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/21/2013] [Indexed: 11/21/2022] Open
Abstract
Background There is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases. The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions. Methods A randomised controlled trial was carried out across 20 health centres in Bilbao (Basque Country, Spain) to assess the impact of home telemonitoring on in-home chronic patients compared with standard care. The study lasted for one year. Fifty-eight in-home patients, diagnosed with heart failure (HF) and/or chronic lung disease (CLD), aged 14 or above and with two or more hospital admissions in the previous year were recruited. The intervention consisted of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight, body temperature and the completion of a health status questionnaire using PDAs. Alerts were generated when pre-established thresholds were crossed. The control group (CG) received usual care. The primary outcome measure was the number of hospital admissions that occurred at 12 months post-randomisation. The impact of telemonitoring on the length of hospital stay, use of other healthcare resources and mortality was also explored. Results The intervention group (IG) included 28 patients and the CG 30. Patient baseline characteristics were similar in both groups. Of the 21 intervention patients followed-up for a year, 12 had some admissions (57.1%), compared to 19 of 22 controls (86.4%), being the difference statistically significant (p = 0.033, RR 0.66; 95%CI 0.44 to 0.99). The mean hospital stay was overall 9 days (SD 4.3) in the IG versus 10.7 (SD 11.2) among controls, and for cause-specific admissions 9 (SD 4.5) vs. 11.2 (SD 11.8) days, both without statistical significance (p = 0.891 and 0.927, respectively). Four patients need to be telemonitored for a year to prevent one admission (NNT). There were more telephone contacts in the IG than in the CG (22.6 -SD 16.1- vs. 8.6 -SD 7.2-, p = 0.001), but fewer home nursing visits (15.3 -SD 11.6- vs. 25.4 -SD 26.3-, respectively), though the difference was not statistically significant (p = 0.3603). Conclusions This study shows that telemonitoring of in-home patients with HF and/or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay. Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients. Trial registration Current Controlled Trials
ISRCTN89041993
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Affiliation(s)
- Iñaki Martín-Lesende
- Bilbao Primary Care Health Region, Osakidetza - Basque Health Service, Bizkaia, Spain.
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187
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Damant J, Knapp M, Watters S, Freddolino P, Ellis M, King D. The impact of ICT services on perceptions of the quality of life of older people. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/17549451311313183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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188
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Disler RT, Inglis SC, Davidson PM. Non-pharmacological management interventions for COPD: an overview of Cochrane systematic reviews. Hippokratia 2013. [DOI: 10.1002/14651858.cd010384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rebecca T Disler
- Faculty of Health, University of Technology Sydney; Centre for Cardiovascular and Chronic Care; Building 10, 235 Jones St, Broadway Sydney NSW Australia 2007
| | - Sally C Inglis
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; Centre for Cardiovascular and Chronic Care; Sydney Australia
| | - Patricia M Davidson
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney; Centre for Cardiovascular and Chronic Care; Sydney Australia
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189
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Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, Bardsley M, Steventon A, Knapp M, Henderson C, Rogers A, Sanders C, Fitzpatrick R, Barlow J, Newman SP. Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial. BMJ 2013; 346:f653. [PMID: 23444424 PMCID: PMC3582704 DOI: 10.1136/bmj.f653] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. DESIGN A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively. SETTING Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems. PARTICIPANTS Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009. MAIN OUTCOME MEASURES Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale). RESULTS In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480 ≤ P ≤ 0.904) or available case (0.181 ≤ P ≤ 0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth v usual care) was non-significant for any outcome (complete case cohort 0.273 ≤ P ≤ 0.761; available case cohort 0.145 ≤ P ≤ 0.696). CONCLUSIONS Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients. TRIAL REGISTRATION ISRCTN43002091.
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Affiliation(s)
- Martin Cartwright
- School of Health Sciences, City University London, London EC1A 7QN, UK
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190
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Lazzarini V, Mentz RJ, Fiuzat M, Metra M, O'Connor CM. Heart failure in elderly patients: distinctive features and unresolved issues. Eur J Heart Fail 2013; 15:717-23. [PMID: 23429975 DOI: 10.1093/eurjhf/hft028] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The prevalence of heart failure (HF) increases with age. While clinical trials suggest that contemporary evidence-based HF therapies have reduced morbidity and mortality, these trials largely excluded the elderly. Questions remain regarding the clinical characteristics of elderly HF patients and the impact of contemporary therapies on their outcomes. This review presents the epidemiology of HF in the elderly and summarizes the data on the pathophysiology of the ageing heart. The clinical characteristics, treatment patterns, and outcomes of elderly HF patients are explored. Finally, the main gaps regarding HF therapies in the elderly and the opportunities for future trials are highlighted.
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Affiliation(s)
- Valentina Lazzarini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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191
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Impact of telemonitoring on older adults health-related quality of life: the Tele-ERA study. Qual Life Res 2013; 22:2315-21. [DOI: 10.1007/s11136-013-0361-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/27/2022]
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192
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Malfatto G, Corticelli A, Villani A, Giglio A, Della Rosa F, Branzi G, Facchini M, Parati G. Transthoracic bioimpedance and brain natriuretic peptide assessment for prognostic stratification of outpatients with chronic systolic heart failure. Clin Cardiol 2013; 36:103-9. [PMID: 23377871 DOI: 10.1002/clc.22086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/13/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with chronic heart failure, physical evaluation and clinical judgment may be inadequate for prognostic stratification. HYPOTHESIS Information obtained with simple bedside tests would be helpful in patient management. METHODS We report on 142 outpatients with systolic heart failure seen at our heart failure unit from 2007 to 2010 (ages 69.4 ± 8.9 years; ejection fraction [EF] 30.6 ± 6.1%; 43% with implanted defibrillators and/or resynchronization devices). At their first visit, we assessed levels of brain natriuretic peptide (BNP) (pg/mL), evaluated transthoracic conductance (TFC) (1/kΩ) by transthoracic bioimpedance, and performed echocardiography. RESULTS Four-year mortality was 21.2%. At multivariate analysis, surviving and deceased subjects did not differ regarding New York Heart Association, age, gender, heart failure etiology, or EF at index visit. Patients who died had higher BNP and TFC (BNP = 884 ± 119 pg/mL vs 334 ± 110 pg/mL; TFC = 50 ± 8/kΩ vs 37 ± 7/kΩ, both P < 0.001]. Patients with BNP < 450 pg/mL and TFC < 40/kΩ had a 2.1% 4-year mortality, compared to 46.5% mortality of patients having BNP ≥ 450 pg/mL and TFC ≥ 40/kΩ. BNP ≥ 450 pg/mL and TFC ≥ 40/kΩ showed high sensitivity (91%) and specificity (88%)in identifying patients who died at follow-up. CONCLUSIONS The combined use of BNP and impedance cardiography during the first assessment of a patient in a heart failure unit identified those carrying a worse medium-term prognosis. This approach could help the subsequent management of patients, allowing better clinical and therapeutic strategies.
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Affiliation(s)
- Gabriella Malfatto
- Cardiology Division, Saint Luke Hospital, Italian Auxologic Institute IRCCS, Milan, Italy.
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193
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Wakefield BJ, Scherubel M, Ray A, Holman JE. Nursing interventions in a telemonitoring program. Telemed J E Health 2013; 19:160-5. [PMID: 23356382 DOI: 10.1089/tmj.2012.0098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of telemonitoring of patients with chronic illness in their homes is growing. Current literature does not describe what types of patient problems are addressed by nurses in these programs and what actions are taken in response to identified problems. This study defined and analyzed patient problems and nursing actions delivered in a telemonitoring program focused on chronic disease management. SUBJECTS AND METHODS Data were drawn from a clinical trial that evaluated telemonitoring in patients with comorbid diabetes and hypertension. Using study patient records, patient problems and nursing actions were coded using an inductive approach. RESULTS In total, 2,336 actions were coded for 68 and 65 participants in two intervention groups. The most frequent reasons for contact were reporting information to the primary care provider and lifestyle information related to diabetes and hypertension (e.g., diet, smoking cessation, foot care, and social contacts). The most frequent mode of contact was the study sending a letter to a participant. CONCLUSIONS Detailed descriptions of interventions delivered facilitate analysis of the unique contributions of nurses in the expanding market of telemonitoring, enable identification of the appropriate number and combination of interventions needed to improve outcomes, and make possible more systematic translation of findings to practice. Furthermore, this information can inform calculation of appropriate panel sizes for care managers and the competencies needed to provide this care.
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Affiliation(s)
- Bonnie J Wakefield
- VA Health Services Research and Development Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, Iowa 52246, USA.
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194
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Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS, Davidson PM. Atrial fibrillation and thromboprophylaxis in heart failure: the need for patient-centered approaches to address adherence. Vasc Health Risk Manag 2013; 9:3-11. [PMID: 23345982 PMCID: PMC3551455 DOI: 10.2147/vhrm.s39571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for atrial fibrillation and emphasizes the importance of tailoring individual risk and the importance of weighing the benefits of treatment. Further, this review provides details of innovative and patient-centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy, a comprehensive risk assessment should include evaluation of associated cardiogeriatric conditions, potential for adherence to prescribed therapy, frailty, and functional and cognitive ability.
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Affiliation(s)
- Caleb Ferguson
- Center for Cardiovascular and Chronic Care, University of Technology, Sydney, Australia.
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195
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Voigt J, Mosier M. Remote care costs for congestive heart failure: a systematic review and meta-analysis of randomized controlled trials in the United States comparing remote versus more intensive care settings. ACTA ACUST UNITED AC 2012; 19:192-9. [PMID: 23279184 DOI: 10.1111/chf.12017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/05/2012] [Accepted: 11/11/2012] [Indexed: 12/20/2022]
Abstract
It has been assumed that less intense levels of care for managing heart failure result in a lowering of the overall costs for this care in the United States. The objective of this review was to determine whether this assumption is correct. A systematic review was performed using Medline, technology assessment Web sites, and relevant cardiovascular and heart failure journals from the year 2000 to the present. US randomized controlled trials where costs were evaluated as one of the endpoints were included. Data were collected using Cochrane Review characteristics of included studies and risk of bias assessment forms. Cost data from each trial were converted to a uniform cost definition and year. Meta-analysis was performed where appropriate. Ten trials were identified evaluating costs at various time points (3, 6, and 12 months). Meta-analysis of trials demonstrated no difference in costs for care, no matter the patient condition or settings. In high-quality trials examining costs, there may be a shifting in costs from more expensive care settings to less expensive care settings without savings to the healthcare system. Larger and longer-term trials should be undertaken to understand this issue.
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Affiliation(s)
- Jeffrey Voigt
- Medical Device Consultants of Ridgewood, LLC, Ridgewood, NJ, USA.
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196
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Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012; 12:139. [PMID: 23194420 PMCID: PMC3520721 DOI: 10.1186/1472-6947-12-139] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/26/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A pilot experimentation of a telemonitoring system for chronic care patients is conducted in the Bilbao Primary Care Health Region (Basque Country, Spain). It seems important to understand the factors related to healthcare professionals' acceptance of this new technology in order to inform its extension to the whole healthcare system.This study aims to examine the psychosocial factors related to telemonitoring acceptance among healthcare professionals and to apply a theory-based instrument. METHODS A validated questionnaire, based on an extension of the Technology Acceptance Model (TAM), was distributed to a total of 605 nurses, general practitioners and paediatricians. Logistic regression analysis was performed to test the theoretical model. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) were computed. RESULTS A response rate of 44.3% was achieved. The original TAM model was good at predicting intention to use the telemonitoring system. However, the extended model, that included other theoretical variables, was more powerful. Perceived Usefulness, Compatibility, and Facilitators were the significant predictors of intention. A detailed analysis showed that intention to use telemonitoring was best predicted by healthcare professionals' beliefs that they would obtain adequate training and technical support and that telemonitoring would require important changes in their practice. CONCLUSION The extended TAM explained a significant portion of the variance in healthcare professionals' intention to use a telemonitoring system for chronic care patients in primary care. The perception of facilitators in the organisational context is the most important variable to consider for increasing healthcare professionals' intention to use the new technology.
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Affiliation(s)
- José Asua
- Department of Health and Consumer Affairs, Basque Government, Office for Health Technology Assessment (Osteba), Vitoria-Gasteiz, Spain
- Department of Health and Consumer Affairs, Basque Government, Direction of Knowledge Management and Evaluation, Vitoria-Gasteiz, Spain
| | - Estibalitz Orruño
- Department of Health and Consumer Affairs, Basque Government, Office for Health Technology Assessment (Osteba), Vitoria-Gasteiz, Spain
| | - Eva Reviriego
- Department of Health and Consumer Affairs, Basque Government, Office for Health Technology Assessment (Osteba), Vitoria-Gasteiz, Spain
| | - Marie Pierre Gagnon
- Faculty of Nursing Sciences, Université Laval, Québec, Canada
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada
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197
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Gund A, Lindecrantz K, Schaufelberger M, Patel H, Sjöqvist BA. Attitudes among healthcare professionals towards ICT and home follow-up in chronic heart failure care. BMC Med Inform Decis Mak 2012. [PMID: 23190602 PMCID: PMC3537518 DOI: 10.1186/1472-6947-12-138] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND eHealth applications for out-of-hospital monitoring and treatment follow-up have been advocated for many years as a promising tool to improve treatment compliance, promote individualized care and obtain a person-centred care. Despite these benefits and a large number of promising projects, a major breakthrough in everyday care is generally still lacking. Inappropriate organization for eHealth technology, reluctance from users in the introduction of new working methods, and resistance to information and communication technology (ICT) in general could be reasons for this. Another reason may be attitudes towards the potential in out-of-hospital eHealth applications. It is therefore of interest to study the general opinions among healthcare professionals to ICT in healthcare, as well as the attitudes towards using ICT as a tool for patient monitoring and follow-up at home. One specific area of interest is in-home follow-up of elderly patients with chronic heart failure (CHF). The aim of this paper is to investigate the attitudes towards ICT, as well as distance monitoring and follow-up, among healthcare professionals working with this patient group. METHOD This paper covers an attitude survey study based on responses from 139 healthcare professionals working with CHF care in Swedish hospital departments, i.e. cardiology and medicine departments. Comparisons between physicians and nurses, and in some cases between genders, on attitudes towards ICT tools and follow-up at home were performed. RESULTS Out of the 425 forms sent out, 139 were collected, and 17 out of 21 counties and regions were covered in the replies. Among the respondents, 66% were nurses, 30% physicians and 4% others. As for gender, 90% of nurses were female and 60% of physicians were male. Internet was used daily by 67% of the respondents. Attitudes towards healthcare ICT were found positive as 74% were positive concerning healthcare ICT today, 96% were positive regarding the future of healthcare ICT, and 54% had high confidence in healthcare ICT. Possibilities for distance monitoring/follow-up are good according to 63% of the respondents, 78% thought that this leads to increased patient involvement, and 80% thought it would improve possibilities to deliver better care. Finally, 72% of the respondents said CHF patients would benefit from home monitoring/follow-up to some extent, and 19% to a large extent. However, the best method of follow-up was considered to be home visits by nurse, or phone contact. CONCLUSION The results indicate that a majority of the healthcare professionals in this study are positive to both current and future use of ICT tools in healthcare and home follow-up. Consequently other factors have to play an important role in the slow penetration of out-of-hospital eHealth applications in daily healthcare practice.
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Affiliation(s)
- Anna Gund
- Department of Signals and Systems, Chalmers University of Technology, Gothenburg, 412 96, Sweden.
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198
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Riley JP, Gabe JP, Cowie MR. Does telemonitoring in heart failure empower patients for self-care? A qualitative study. J Clin Nurs 2012. [PMID: 23185992 DOI: 10.1111/j.1365-2702.2012.04294.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the extent to which telemonitoring in patients with heart failure empowers them to self-care. BACKGROUND Telemonitoring is increasingly used to provide structured follow-up. In patients with heart failure it has been shown to reduce mortality. However there is limited knowledge of the extent to which it supports the patient to develop self-care skills. DESIGN A qualitative study including interviews with patients at 2 time-points. METHODS Fifteen patients mean age 74, 11 (73%) male, 9 (60%) symptomatic on moderate activity, 6 (40%) symptomatic on mild exertion were interviewed at two time points: firstly following three months of telemonitoring and the second interview following six months of telemonitoring. Thematic analysis of the data was undertaken using constant comparison. RESULTS Patients undertook a variety of self-care actions. During the three-month interview technological skills featured highly in patients accounts and they used telemonitoring to facilitate professional monitoring. However, during the six-month interview patients described how they used telemonitoring to support their self-care actions. Such actions were based on the understanding of heart failure that patients developed from their personal experience of symptoms, and their interaction with the telemonitoring and the telemonitoring nurse. We found no difference in self-care actions regardless of patients age, severity of their heart failure, time since diagnosis with heart failure or living alone. CONCLUSION In summary, the majority of patients used telemonitoring daily and developed self-care skills in monitoring their heart failure. Such skills were developed over the six-month time-period of the study. RELEVANCE TO CLINICAL PRACTICE Our findings suggest how the nurse can help patients to use telemonitoring to develop their understanding of their heart failure and empower them for self- care decision making.
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Affiliation(s)
- Jillian P Riley
- Royal Brompton & Harefield NHS Foundation Trust, London, UK.
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199
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CHU SH, LEE WH, YOO JS, KIM SS, KO IS, OH EG, LEE J, CHOI M, CHEON JY, SHIM CY, KANG SM. Factors affecting quality of life in Korean patients with chronic heart failure. Jpn J Nurs Sci 2012; 11:54-64. [DOI: 10.1111/jjns.12002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 09/09/2012] [Indexed: 01/28/2023]
Affiliation(s)
- Sang Hui CHU
- Nursing Policy and Research Institute; Biobehavioral Research Center; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Won Hee LEE
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Ji Soo YOO
- Nursing Policy and Research Institute; Biobehavioral Research Center; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - So Sun KIM
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Il Sun KO
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Eui Geum OH
- Nursing Policy and Research Institute; Biobehavioral Research Center; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - JuHee LEE
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Mona CHOI
- Nursing Policy and Research Institute; Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Joo Young CHEON
- Division of Clinical Nursing Science; Yonsei University College of Nursing; Seoul Korea
| | - Chi Young SHIM
- Divisiont of Cardiology; Yonsei University College of Medicine; Seoul Korea
| | - Seok-Min KANG
- Divisiont of Cardiology; Yonsei University College of Medicine; Seoul Korea
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200
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Jaarsma T, Nikolova-Simons M, van der Wal MH. Nurses' strategies to address self-care aspects related to medication adherence and symptom recognition in heart failure patients: An in-depth look. Heart Lung 2012; 41:583-93. [DOI: 10.1016/j.hrtlng.2012.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 02/03/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
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