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Cost-effectiveness of telehealth interventions for chronic heart failure patients: a literature review. Int J Technol Assess Health Care 2014; 30:59-68. [PMID: 24495581 DOI: 10.1017/s0266462313000779] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evidence exists that telehealth interventions (e.g., telemonitoring, telediagnostics, telephone care) in disease management for chronic heart failure patients can improve medical outcomes, and we aim to give an overview of the cost-effectiveness of these interventions. METHODS Based on the literature search on "heart failure" in combination with "cost" and "telehealth" we selected 301 titles and abstracts. Titles and abstracts were screened for a set of inclusion criteria: telehealth intervention, heart failure as the main disease, economic analysis present and a primary study performed. In the end, thirty-two studies were included for full reading, data extraction, and critical appraisal of the economic evaluation. RESULTS Most studies did not present a comprehensive economic evaluation, consisting of the comparison of both costs and effects between telehealth intervention and a comparator. Data on telehealth investment costs were lacking in many studies. The few studies that assessed costs and consequences comprehensively showed that telehealth interventions are cost saving with slight improvement in effectiveness, or comparably effective with similar cost to usual care. However, the methodological quality of the studies was in general considered to be low. CONCLUSIONS The cost-effectiveness of telehealth in chronic heart failure is hardly ascertained in peer reviewed literature, the quality of evidence is poor and there was a difficulty in capturing all of the consequences/effects of telehealth intervention. We believe that without full economic analyses the cost-effectiveness of telehealth interventions in chronic heart failure remains unknown.
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202
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Schwamm LH. Telehealth: Seven Strategies To Successfully Implement Disruptive Technology And Transform Health Care. Health Aff (Millwood) 2014; 33:200-6. [DOI: 10.1377/hlthaff.2013.1021] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lee H. Schwamm
- Lee H. Schwamm ( ) is executive vice chair of neurology and medical director of telehealth at Massachusetts General Hospital, in Boston. He directs the Massachusetts General Hospital and Partners TeleStroke Network
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203
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de Jong CC, Ros WJ, Schrijvers G. The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review. J Med Internet Res 2014; 16:e19. [PMID: 24434570 PMCID: PMC3913926 DOI: 10.2196/jmir.3000] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/11/2013] [Accepted: 12/21/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions. OBJECTIVE The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction. METHODS A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction. RESULTS Patients' knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes. CONCLUSIONS The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed.
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Affiliation(s)
- Catharina Carolina de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands.
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204
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Harkness K, Heckman GA, McKelvie RS. The older patient with heart failure: high risk for frailty and cognitive impairment. Expert Rev Cardiovasc Ther 2014; 10:779-95. [DOI: 10.1586/erc.12.49] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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205
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Davidson PM, Inglis SC, Newton PJ. Self-care in patients with chronic heart failure. Expert Rev Pharmacoecon Outcomes Res 2014; 13:351-9. [DOI: 10.1586/erp.13.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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206
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Pressman AR, Kinoshita L, Kirk S, Barbosa GM, Chou C, Minkoff J. A novel telemonitoring device for improving diabetes control: protocol and results from a randomized clinical trial. Telemed J E Health 2014; 20:109-14. [PMID: 24404816 DOI: 10.1089/tmj.2013.0157] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Telemedicine is one approach to managing patients with chronic illness. Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL) levels. The purpose of this study was to evaluate an investigational in-home telemetry device for improving glucose and BP control over 6 months for patients with type 2 diabetes. The device was used to transmit weekly blood glucose, weight, and BP readings to a diabetes care manager. SUBJECTS AND METHODS We conducted a two-arm, parallel-comparison, single-blind, randomized controlled trial among Kaiser Permanente Northern California members 18-75 years old with type 2 diabetes mellitus and entry HbA1c levels between 7.5% and 10.0%. Participants were randomly assigned to either the telemonitoring arm or the usual care arm. RESULTS We observed very small, nonsignificant changes in fructosamine (telemonitoring, -54.9 μmol; usual care, -59.4 μmol) and systolic BP (telemonitoring, -6.3 mm Hg; usual care, -3.2 mm Hg) from baseline to 6 weeks in both groups. At 6 months, we observed no significant intergroup differences in change from baseline for HbA1c, fructosamine, or self-efficacy. However, LDL cholesterol in the telemonitoring arm decreased more than in the usual care arm (-17.1 mg/dL versus -5.4 mg/dL; P=0.045). CONCLUSIONS Although HbA1c improved significantly over 6 months in both groups, the difference in improvement between the groups was not significant. This lack of significance may be due to the relatively healthy status of the volunteers in our study and to the high level of care provided by the care managers in the Santa Rosa, CA clinic. Further study in subgroups of less healthy diabetes patients is recommended.
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207
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Nakamura N, Koga T, Iseki H. A meta-analysis of remote patient monitoring for chronic heart failure patients. J Telemed Telecare 2013; 20:11-7. [PMID: 24352899 DOI: 10.1177/1357633x13517352] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We carried out a meta analysis of remote patient monitoring (RPM) for chronic heart failure (CHF) patients. A literature search was used to identify randomised controlled trials with more than 40 patients, published between February 2003 and February 2013. The primary outcome (mortality) was analysed using a random effect model. Thirteen studies were included (3337 patients). RPM resulted in a significantly lower mortality (risk ratio 0.76; 95% confidence interval 0.62 to 0.93) compared to usual care. The test for heterogeneity showed that articles had been extracted homogeneously (I(2)=0%, P=0.67). In order to determine which RPM model was most effective, subgroup analyses were conducted by age, severity of illness, measurement frequency, medication management and speed of intervention. The group with rapid intervention had the lowest mortality (rapid group risk ratio=0.59, non-rapid group risk ratio=0.88, P=0.05). The group with high measurement frequency had lower mortality (high frequency group risk ratio=0.62, low frequency group risk ratio=0.89, P=0.07). The group with medication management had lower mortality (medication group risk ratio=0.65, non medication group risk ratio=0.85, P=0.19). RPM is effective in chronic heart failure and rapid intervention was the most important factor in the RPM model.
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Affiliation(s)
- Naoto Nakamura
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan
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208
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Sales VL, Ashraf MS, Lella LK, Huang J, Bhumireddy G, Lefkowitz L, Feinstein M, Kamal M, Caesar R, Cusick E, Norenberg J, Lee J, Brener S, Sacchi TJ, Heitner JF. Utilization of Trained Volunteers Decreases 30-Day Readmissions for Heart Failure. J Card Fail 2013; 19:842-50. [DOI: 10.1016/j.cardfail.2013.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 10/19/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
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Krum H, Driscoll A. Management of heart failure. Med J Aust 2013; 199:334-9. [PMID: 23992190 DOI: 10.5694/mja12.10993] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/30/2013] [Indexed: 12/20/2022]
Abstract
Heart failure is a complex clinical syndrome, with diagnosis based on typical symptoms, signs and supportive investigations. Investigations may include an electrocardiogram and chest x-ray, but echocardiography is the definitive test. Plasma B-type natriuretic peptide levels may also be useful in diagnosis among patients with breathlessness, particularly as a rule-out test.Mainstay therapy for heart failure comprises lifestyle modification, pharmacotherapy and referral to a multidisciplinary heart failure program.Drug therapies focused on blockade of key activated neurohormonal systems are well established in systolic heart failure. First-line pharmacotherapy consists of angiotensin-converting enzyme (ACE) inhibitors (or angiotensin receptor blockers if the patient is intolerant to ACE inhibitors) and β-blockers. These medications should be commenced at a low dose and slowly up-titrated to the maximal tolerated dose. In selected patients, device-based therapies are a useful adjunct in systolic heart failure. The most common of these are implantable cardioverter defibrillators and cardiac resynchronisation therapy. Most patients will receive both, as the indications overlap. Multidisciplinary approaches, including involvement of the patient's general practitioner, are strongly recommended.
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Affiliation(s)
- Henry Krum
- Monash University, Melbourne, Australia.
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211
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Ota KS, Beutler DS, Sheikh H, Weiss JL, Parkinson D, Nguyen P, Gerkin RD, Loli AI. Direct Telephonic Communication in a Heart Failure Transitional Care Program: An observational study. Cardiol Res 2013; 4:145-151. [PMID: 28352437 PMCID: PMC5358199 DOI: 10.4021/cr296e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 11/26/2022] Open
Abstract
Background This study investigated the trend of phone calls in the Banner Good Samaritan Medical Center (BGSMC) Heart Failure Transitional Care Program (HFTCP). The primary goal of the HFTCP is to reduce 30-Day readmissions for heart failure patients by using a multi-pronged approach. Methods This study included 104 patients in the HFTCP discharged over a 51-week period who had around-the-clock telephone access to the Transitionalist. Cellular phone records were reviewed. This study evaluated the length and timing of calls. Results A total of 4398 telephone calls were recorded of which 39% were inbound and 61% were outbound. This averaged to 86 calls per week. During the “Weekday Daytime” period, Eighty-five percent of the totals calls were made. There were 229 calls during the “Weekday Nights” period with 1.5 inbound calls per week. The “Total Weekend” calls were 10.2% of the total calls which equated to a weekly average of 8.8. Conclusions Our experience is that direct, physician-patient telephone contact is feasible with a panel of around 100 HF patients for one provider. If the proper financial reimbursements are provided, physicians may be apt to participate in similar transitional care programs. Likewise, third party payers will benefit from the reduction in unnecessary emergency room visits and hospitalizations.
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Affiliation(s)
- Ken S Ota
- Department of Transitional Care Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - David S Beutler
- Cardiology Fellowship Program, Banner Good Samaritan Medical Center, Phoenix, Arizona
| | - Hassam Sheikh
- Department of Transitional Care Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - Jessica L Weiss
- Internal Medicine Residency Program, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - Dallin Parkinson
- Department of Transitional Care Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - Peter Nguyen
- Department of Transitional Care Medicine, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - Richard D Gerkin
- Internal Medicine Residency Program, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - Akil I Loli
- Cardiology Fellowship Program, Banner Good Samaritan Medical Center, Phoenix, Arizona
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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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213
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Conway A, Inglis SC, Chang AM, Horton-Breshears M, Cleland JGF, Clark RA. Not all systematic reviews are systematic: a meta-review of the quality of systematic reviews for non-invasive remote monitoring in heart failure. J Telemed Telecare 2013; 19:326-37. [PMID: 24163297 DOI: 10.1177/1357633x13503427] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We carried out a critical appraisal and synthesis of the systematic reviews and meta-analyses of remote monitoring for heart failure. A comprehensive literature search identified 65 relevant publications from 3333 citations. Seventeen studies fulfilled the inclusion and exclusion criteria. Seven (41%) systematic reviews pooled results for meta-analysis. Eight (47%) considered all non-invasive remote monitoring strategies. Five (29%) focused on telemonitoring. Four (24%) included both non-invasive and invasive technologies. The reviews were appraised by two independent reviewers for their quality and risk of bias using the AMSTAR tool. According to the AMSTAR criteria, ten (58%) systematic reviews were of poor methodological quality. In the high quality reviews, the relative risk of mortality in patients who received remote monitoring ranged from 0.53 to 0.88. The high quality reviews also reported that remote monitoring reduced the relative risk of all-cause (0.52 to 0.96) and heart failure-related hospitalizations (0.72 to 0.79) and, as a consequence, healthcare costs. However, further research is required before considering widespread implementation of remote monitoring. The subset of the heart failure population that derives the most benefit from intensive monitoring, the best technology, and the optimum duration of monitoring, all need to be identified.
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Affiliation(s)
- Aaron Conway
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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214
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Guidi G, Pettenati MC, Miniati R, Iadanza E. Heart failure analysis dashboard for patient's remote monitoring combining multiple artificial intelligence technologies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:2210-3. [PMID: 23366362 DOI: 10.1109/embc.2012.6346401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper we describe an Heart Failure analysis Dashboard that, combined with a handy device for the automatic acquisition of a set of patient's clinical parameters, allows to support telemonitoring functions. The Dashboard's intelligent core is a Computer Decision Support System designed to assist the clinical decision of non-specialist caring personnel, and it is based on three functional parts: Diagnosis, Prognosis, and Follow-up management. Four Artificial Intelligence-based techniques are compared for providing diagnosis function: a Neural Network, a Support Vector Machine, a Classification Tree and a Fuzzy Expert System whose rules are produced by a Genetic Algorithm. State of the art algorithms are used to support a score-based prognosis function. The patient's Follow-up is used to refine the diagnosis.
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Affiliation(s)
- G Guidi
- Department of Electronics and Telecommunications, University of Florence, Florence, Italy.
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215
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Giordano A, Scalvini S, Paganoni AM, Baraldo S, Frigerio M, Vittori C, Borghi G, Marzegalli M, Agostoni O. Home-Based Telesurveillance Program in Chronic Heart Failure: Effects on Clinical Status and Implications for 1-Year Prognosis. Telemed J E Health 2013; 19:605-12. [DOI: 10.1089/tmj.2012.0250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amerigo Giordano
- Institute of Care and Scientific Research, Salvatore Maugeri Foundation, Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Institute of Care and Scientific Research, Salvatore Maugeri Foundation, Lumezzane, Brescia, Italy
| | - Anna Maria Paganoni
- Modeling and Scientific Computing, Department of Mathematics, Politecnico, Milan, Italy
| | - Stefano Baraldo
- Modeling and Scientific Computing, Department of Mathematics, Politecnico, Milan, Italy
| | - Maria Frigerio
- Department of Cardiology, Hospital Niguarda, Milan, Italy
| | | | - Gabriella Borghi
- Center of Excellence for Research, Innovation, Education, and Industrial Labs Partnership (CEFRIEL), Milan, Italy
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216
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Home-based versus in-hospital cardiac rehabilitation after cardiac surgery: a nonrandomized controlled study. Phys Ther 2013; 93:1073-83. [PMID: 23599353 DOI: 10.2522/ptj.20120212] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise rehabilitation after cardiac surgery has beneficial effects, especially on a long-term basis. Rehabilitative programs with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home. OBJECTIVE The purpose of this study was to compare exercise capacity after home-based cardiac rehabilitation (HBCR) or in-hospital rehabilitation in patients at low to medium risk for early mortality (EuroSCORE 0-5) following cardiac surgery. DESIGN A quasi-experimental study was conducted. METHODS At hospital discharge, patients were given the option to decide whether to enroll in the HBCR program. Clinical examinations (electrocardiography, cardiac echo color Doppler, chest radiography, blood samples) of patients in the HBCR group were collected during 4 weeks of rehabilitation, and exercise capacity (assessed using the Six-Minute Walk Test [6MWT]) was assessed before and after rehabilitation. A group of patients admitted to the in-hospital rehabilitation program was used as a comparison group. Patients in the HBCR group were supervised at home by a medical doctor and telemonitored daily by a nurse and physical therapist by video conference. Periodic home visits by health staff also were performed. RESULTS One hundred patients were recruited into the HBCR group. An equal number of patients was selected for the comparison group. At the end of the 4-week study, the 2 groups showed improvement from their respective baseline values only in the 6MWT. No difference was found in time × group interaction. LIMITATIONS Because patients self-selected to enroll in the HBCR program and because they were enrolled from a single clinical center, the results of the study cannot be generalized. CONCLUSIONS In patients who self-selected HBCR, the program was found to be effective and comparable to the standard in-hospital rehabilitative approach, indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service.
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217
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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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218
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Krum H, Forbes A, Yallop J, Driscoll A, Croucher J, Chan B, Clark R, Davidson P, Huynh L, Kasper EK, Hunt D, Egan H, Stewart S, Piterman L, Tonkin A. Telephone Support to Rural and Remote Patients with Heart Failure: The Chronic Heart Failure Assessment by Telephone (CHAT) study. Cardiovasc Ther 2013; 31:230-7. [DOI: 10.1111/1755-5922.12009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
| | - Andrew Forbes
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
| | - Julie Yallop
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery; Deakin University; Melbourne; Vic.; Australia
| | - Jo Croucher
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
| | - Bianca Chan
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
| | - Robyn Clark
- Queensland University of Technology; Brisbane; QLD; Australia
| | | | - Luan Huynh
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
| | - Edward K. Kasper
- School of Medicine; Johns Hopkins University; Washington; DC; USA
| | - David Hunt
- Department of Medicine; University of Melbourne; Melbourne; Vic.; Australia
| | - Helen Egan
- Barwon Management Group; Darwin; NT; Australia
| | | | - Leon Piterman
- School of Primary Health Care; Monash University; Melbourne; Vic.; Australia
| | - Andrew Tonkin
- Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne; Vic.; Australia
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Harkness K, Heckman GA, Akhtar-Danesh N, Demers C, Gunn E, McKelvie RS. Cognitive function and self-care management in older patients with heart failure. Eur J Cardiovasc Nurs 2013; 13:277-84. [PMID: 23733350 DOI: 10.1177/1474515113492603] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS People with heart failure have difficulty with self-care management. We do not know if patients with heart failure have difficulty with self-care management due to underlying, mild cognitive impairment (MCI). The purpose of this study was to determine whether MCI, as identified on a simple screening tool, is significantly associated with self-care management in a sample of community dwelling older patients with heart failure. METHODS AND RESULTS Using a cross-sectional design, heart failure patients (n=100, mean age 72 SD 10 years) attending an outpatient heart failure clinic completed the Montreal Cognitive Assessment tool (MoCA), Self-Care in Heart Failure Index (SCHFI) and Geriatric Depression Scale. The presence of MCI, as defined by a MoCA score <26, was present in 73% patients; 21% had an adequate self-care management SCHFI score; and 12% reported symptoms of depression. Participants with a MoCA score <26 vs. ≥ 26 scored significantly lower on the self-care management subscale of the SCHFI (48.1 SD 24 vs. 59.3 SD 22 respectively, p=0.035). Using backward regression, the final model was fitted to self-care management while controlling for age and sex and was significant, with (F= 7.04 df (3, 96), and p<0.001), accounting for 18% of the total variance in self-care management (R (2) = 18.03%). The MoCA score was the only variable which remained in the model significantly with p= 0.001. CONCLUSION Findings from this study highlight the difficulty older heart failure patients have with self-care management and the need to include formal screening for MCI when exploring variables contributing to self-care management in heart failure patients.
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Pericás JM, Aibar J, Soler N, López-Soto A, Sanclemente-Ansó C, Bosch X. Should alternatives to conventional hospitalisation be promoted in an era of financial constraint? Eur J Clin Invest 2013; 43:602-15. [PMID: 23590593 DOI: 10.1111/eci.12087] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because the current economic crisis has led to austerity in health policies, with severe restrictions on public health care, avoiding unnecessary admissions and shortening hospital stays is rapidly becoming an urgent priority. Alternatives to hospitalisation replace or shorten hospital processes, including diagnosis, monitoring, treatment and follow-up. This review aims to present the available evidence on alternatives to conventional hospitalisation for medical disorders; options for surgery, psychiatry and palliative care are largely excluded. MATERIALS AND METHODS Narrative review. RESULTS The main alternatives to conventional hospitalisation include day centres (DC), quick diagnosis units (QDU), hospital at home (HaH) and, in some circumstances, telemonitoring. DC increase patient comfort, reduce costs and can improve efficiency. In generally healthy patients with suspected severe disease, QDU may be a good alternative to hospitalisation for diagnostic procedures. However, their cost-effectiveness remains to be clearly proven. Randomised controlled trials have shown that hospital-at-home (HaH) can lead to earlier hospital discharges, improve outcomes and reduce costs in patients with prevalent chronic diseases. Although telemonitoring seems to be promising and its use is increasing, methodologically sounder studies with a higher level of evidence are needed to assess its clinical effectiveness. CONCLUSIONS Factors such as ageing, the need for an earlier diagnosis of suspected severe disease, the increasing complexity of medical care and the increasing costs of hospitalisation mean that, whenever possible, giving priority to less expensive alternatives to hospital admission, such as QDU, DC, HaH and telemedicine, is an urgent task in the current economic crisis.
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Affiliation(s)
- Juan M Pericás
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Roger VL. The changing landscape of heart failure hospitalizations. J Am Coll Cardiol 2013; 61:1268-70. [PMID: 23500329 DOI: 10.1016/j.jacc.2013.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
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Méndez Bailón M, Audibert Mena L. Medidas para la prevención de re-hospitalizaciones en Medicina Interna. Rev Clin Esp 2013; 213:217. [DOI: 10.1016/j.rce.2012.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/21/2012] [Indexed: 10/27/2022]
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de Vries AE, van der Wal MHL, Nieuwenhuis MMW, de Jong RM, van Dijk RB, Jaarsma T, Hillege HL, Jorna RJ. Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients. BMC Med Inform Decis Mak 2013; 13:54. [PMID: 23622342 PMCID: PMC3651365 DOI: 10.1186/1472-6947-13-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/18/2013] [Indexed: 11/27/2022] Open
Abstract
Background Clinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T). Methods A questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed. Results The response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01). Conclusions Both cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.
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Affiliation(s)
- Arjen E de Vries
- Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Chen YH, Lin YH, Hung CS, Huang CC, Yeih DF, Chuang PY, Ho YL, Chen MF. Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study. J Med Internet Res 2013; 15:e87. [PMID: 23615318 PMCID: PMC3636317 DOI: 10.2196/jmir.2091] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 07/25/2012] [Accepted: 03/19/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth based on advanced information technology is an emerging health care strategy for managing chronic diseases. However, the cost-effectiveness and clinical effect of synchronous telehealth services in older patients with cardiovascular diseases has not yet been studied. Since 2009, the Telehealth Center at the National Taiwan University Hospital has provided a range of telehealth services (led by a cardiologist and staffed by cardiovascular nursing specialists) for cardiovascular disease patients including (1) instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis, (2) mutual telephone communication and health promotion, and (3) continuous analytical and decision-making support. OBJECTIVE To evaluate the impact of a synchronous telehealth service on older patients with cardiovascular diseases. METHODS Between November 2009 and April 2010, patients with cardiovascular disease who received telehealth services at the National Taiwan University Hospital were recruited. We collected data on hospital visits and health expenditures for the 6-month period before and the 6-month period after the opening of the Telehealth Center to assess the clinical impact and cost-effectiveness of telehealth services on cardiovascular patients. RESULTS A total of 141 consecutive cardiovascular disease patients were recruited, including 93 aged ≥65 years (senior group) and 48 aged <65 years (nonsenior group). The telehealth intervention significantly reduced the all-cause admission rate per month per person in the nonsenior group (pretelehealth: median 0.09, IQR 0-0.14; posttelehealth: median 0, IQR 0-0; P=.002) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.70, IQR 0-1.96; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 0.77, IQR 0.20-1.64; posttelehealth: mean 1.60, IQR 1.06-2.57; P=.002). In the senior group, the telehealth intervention also significantly reduced the all-cause admission rate per month per person (pretelehealth: median 0.10, IQR 0-0.18; posttelehealth: median 0, IQR 0-0; P<.001) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.59, IQR 0-2.24; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 1.40, IQR 0.52-2.63; posttelehealth: median 1.76, IQR 1.12-2.75; P=.02). In addition, telehealth intervention reduced the inpatient cost in the nonsenior group from $814.93 (SD 1000.40) to US $217.39 (SD 771.01, P=.001) and the total cost per month from US $954.78 (SD 998.70) to US $485.06 (SD 952.47, P<.001). In the senior group, the inpatient cost per month was reduced from US $768.27 (SD 1148.20) to US $301.14 (SD 926.92, P<.001) and the total cost per month from US $928.20 (SD 1194.11) to US $494.87 (SD 1047.08, P<.001). CONCLUSIONS Synchronous telehealth intervention may reduce costs, decrease all-cause admission rates, and decrease durations of all-cause hospital stays in cardiovascular disease patients, regardless of age.
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Affiliation(s)
- Ying-Hsien Chen
- National Taiwan University Hospital, Departments of Internal Medicine, Taipei, Taiwan
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Kommentar zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Behandlung der akuten und chronischen Herzinsuffizienz. KARDIOLOGE 2013. [DOI: 10.1007/s12181-013-0491-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Guzman-Clark JRS, van Servellen G, Chang B, Mentes J, Hahn TJ. Predictors and Outcomes of Early Adherence to the Use of a Home Telehealth Device by Older Veterans with Heart Failure. Telemed J E Health 2013; 19:217-23. [DOI: 10.1089/tmj.2012.0096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Jenice Ria S. Guzman-Clark
- VA Greater Los Angeles Healthcare System Geriatric Research, Education & Clinical Center, Los Angeles, California
- UCLA School of Nursing, Los Angeles, California
| | | | - Betty Chang
- UCLA School of Nursing, Los Angeles, California
| | | | - Theodore J. Hahn
- VA Greater Los Angeles Healthcare System Geriatric Research, Education & Clinical Center, Los Angeles, California
- UCLA School of Medicine, Los Angeles, California
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Mussi CM, Ruschel K, Souza END, Lopes ANM, Trojahn MM, Paraboni CC, Rabelo ER. Home visit improves knowledge, self-care and adhesion in heart failure: randomized Clinical Trial HELEN-I. Rev Lat Am Enfermagem 2013; 21 Spec No:20-8. [DOI: 10.1590/s0104-11692013000700004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/31/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. METHODS: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. RESULTS: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and P<0.001), respectively; the adhesion to the treatment, measured and compared between the groups, was significantly higher in the intervention group (P=0.001). CONCLUSION: the strategy of home visits to patients who were recently hospitalized with decompensated heart failure was effective in improving the outcomes assessed and its implementation deserves to be considered in Brazil aiming at avoiding unplanned hospitalizations. NCT-01213862
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Benbassat J, Taragin MI. The effect of clinical interventions on hospital readmissions: a meta-review of published meta-analyses. Isr J Health Policy Res 2013; 2:1. [PMID: 23343012 PMCID: PMC3557155 DOI: 10.1186/2045-4015-2-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/13/2012] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED BACKGROUND The economic impact and ease of measurement of all-cause hospital readmission rates (HRR) have led to the current debate as to whether they are reducible, and whether they should be used as a publicly reported quality indicators of medical care. OBJECTIVE To assess the efficacy of broad clinical interventions in preventing HRR of patients with chronic diseases METHOD A meta-review of published systematic reviews of randomized controlled trials (RCTs) of clinical interventions that have included HRR among the patients' outcomes of interest. MAIN FINDINGS Meta-analyses of RCTs have consistently found that, in the community, disease management programs significantly reduced HRR in patients with heart failure, coronary heart disease and bronchial asthma, but not in patients with stroke and in unselected patients with chronic disorders. Inhospital interventions, such as discharge planning, pharmacological consultations and multidisciplinary care, and community interventions in patients with chronic obstructive pulmonary diseases had an inconsistent effect on HRR. MAIN STUDY LIMITATION: Despite their economic impact and ease of measurement, HRR are not the most important outcome of patient care, and efforts aimed at their reduction may compromise patients' health by reducing also justified re-admissions. CONCLUSIONS The efficacy of inhospital interventions in reducing HRR is in need of further study. In patients with heart diseases and bronchial asthma, HRR may be considered as a publicly reported quality indicator of community care, provided that future research confirms that efforts to reduce HRR do not adversely affect other patients' outcomes, such as mortality, functional capacity and quality of life. Future research should also focus on the reasons for the higher efficacy of community interventions in patients with heart diseases and bronchial asthma than in those with other chronic diseases.
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Affiliation(s)
- Jochanan Benbassat
- JDC Brookdale Institute, Health Policy Research Program, PO Box 3886, Jerusalem, 91037, Israel
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de Vries AE, van der Wal MHL, Nieuwenhuis MMW, de Jong RM, van Dijk RB, Jaarsma T, Hillege HL. Health professionals' expectations versus experiences of internet-based telemonitoring: survey among heart failure clinics. J Med Internet Res 2013; 15:e4. [PMID: 23305645 PMCID: PMC3636294 DOI: 10.2196/jmir.2161] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/27/2012] [Accepted: 09/24/2012] [Indexed: 12/16/2022] Open
Abstract
Background Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. Objective To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. Methods In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. Results Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are “monitoring physical condition”, “monitoring signs of deterioration” (n=39, 91%), “monitoring treatment” (n=32, 74%), “adjusting medication” (n=24, 56%), and “educating patients” (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system “as long as needed” or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (P<.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to “keeping up with current development” (before 7.2, after 6.8, P=.15), “being innovative” (before 7.0, after 6.1, P=.003), and “better guideline adherence” (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time. Conclusions One third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment.
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Affiliation(s)
- Arjen E de Vries
- University Medical Center Groningen, Cardiology, Groningen, Netherlands.
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231
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Shoaib A, Mabote T, Zuhair M, Kassianides X, Cleland JGF. Acute heart failure (suspected or confirmed): Initial diagnosis and subsequent evaluation with traditional and novel technologies. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.33046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ledwidge MT, O'Hanlon R, Lalor L, Travers B, Edwards N, Kelly D, Voon V, McDonald KM. Can individualized weight monitoring using the HeartPhone algorithm improve sensitivity for clinical deterioration of heart failure? Eur J Heart Fail 2012. [PMID: 23204211 DOI: 10.1093/eurjhf/hfs186] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIMS Previous studies have demonstrated poor sensitivity of guideline weight monitoring in predicting clinical deterioration of heart failure (HF). This study aimed to evaluate patterns of remotely transmitted daily weights in a high-risk HF population and also to compare guideline weight monitoring and an individualized weight monitoring algorithm. METHODS AND RESULTS Consenting, consecutive, high-risk patients were provided with a mobile phone-based remote weight telemonitoring device. We aimed to evaluate population vs. individual weight variability, weight patterns pre- and post-events of clinical deterioration of HF, and to compare guideline weight thresholds with the HeartPhone algorithm in terms of sensitivity and specificity for such events. Of 87 patients recruited and followed for an average of 23.9 ± 12 weeks, 19 patients experienced 28 evaluable episodes of clinical deterioration of HF. Following a post-discharge decline, the population average weight remained stable for the follow-up period, yet the 7-day moving average of individual patients exceeded 2 kg in three-quarters of patients. Significant increases in weight were observed up to 4 days before HF events. The HeartPhone algorithm was significantly more sensitive (82%) in predicting HF events than guideline weight thresholds of 2 kg over 2-3 days (21%) and a 'rule of thumb' threshold of 1.36 kg over 1 day (46%). CONCLUSIONS An individualized approach to weight monitoring in HF with the HeartPhone algorithm improved prediction of HF deterioration. Further evaluation of HeartPhone with and without other biomarkers of HF deterioration is warranted.
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Affiliation(s)
- Mark T Ledwidge
- Heart failure Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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233
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Abstract
Not all strategies for the management of chronic heart failure have been shown to be equally effective in improving outcomes, and the ideal programme has yet to be defined. The WHICH? trial sheds some light on whether a clinical, in-hospital or a home-based strategy of care is superior and cost-effective.
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234
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Stewart S. Nurse-Led Care of Heart Failure: Will it Work in Remote Settings? Heart Lung Circ 2012; 21:644-7. [DOI: 10.1016/j.hlc.2012.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/04/2012] [Indexed: 12/01/2022]
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McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, h T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Almenar Bonet L, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Arnold Flachskampf F, Francesco Guida G, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Ørn S, Parissis JT, Ponikowski P. Guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica 2012. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2012.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Stewart S, Carrington MJ, Marwick TH, Davidson PM, Macdonald P, Horowitz JD, Krum H, Newton PJ, Reid C, Chan YK, Scuffham PA. Impact of Home Versus Clinic-Based Management of Chronic Heart Failure. J Am Coll Cardiol 2012; 60:1239-48. [DOI: 10.1016/j.jacc.2012.06.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/29/2012] [Accepted: 06/05/2012] [Indexed: 10/27/2022]
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Vanagas G, Umbrasienė J, Šlapikas R. Effectiveness of telemedicine and distance learning applications for patients with chronic heart failure. A protocol for prospective parallel group non-randomised open label study. BMJ Open 2012; 2:e001346. [PMID: 23015599 PMCID: PMC3467609 DOI: 10.1136/bmjopen-2012-001346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/28/2012] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Chronic heart failure in Baltic Sea Region is responsible for more hospitalisations than all forms of cancer combined and is one of the leading causes of hospitalisations in elderly patients. Frequent hospitalisations, along with other direct and indirect costs, place financial burden on healthcare systems. We aim to test the hypothesis that telemedicine and distance learning applications is superior to the current standard of home care. METHODS AND ANALYSIS Prospective parallel group non-randomised open label study in patients with New York Heart Association (NYHA) II-III chronic heart failure will be carried out in six Baltic Sea Region countries. The study is organised into two 6-month follow-up periods. The first 6-month period is based on active implementation of tele-education and/or telemedicine for patients in two groups (active run period) and one standard care group (passive run period). The second 6-month period of observation will be based on standard care model (passive run period) to all three groups. Our proposed practice change is based on translational research with empirically supported interventions brought to practice and aims to find the home care model that is most effective to patient needs. ETHICS AND DISSEMINATION This study has been approved by National Bioethics Committee (2011-03-07; Registration No: BE-2-11). TRIAL REGISTRATION This study has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12611000834954.
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Affiliation(s)
- Giedrius Vanagas
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jelena Umbrasienė
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimvydas Šlapikas
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences “Kauno Klinikos”, Kaunas, Lithuania
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Tiessen AH, Smit AJ, Broer J, Groenier KH, van der Meer K. Randomized controlled trial on cardiovascular risk management by practice nurses supported by self-monitoring in primary care. BMC FAMILY PRACTICE 2012; 13:90. [PMID: 22947269 PMCID: PMC3503756 DOI: 10.1186/1471-2296-13-90] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/29/2012] [Indexed: 11/26/2022]
Abstract
Background Treatment goals for cardiovascular risk management are generally not achieved. Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid. The aim of this study was to compare standard treatment supported by self-monitoring with standard treatment without self-monitoring, both conducted by practice nurses, on cardiovascular risk and separate risk factors. Methods Men aged 50–75 years and women aged 55–75 years without a history of cardiovascular disease or diabetes, but with a SCORE 10-year risk of cardiovascular mortality ≥5% and at least one treatable risk factor (smoking, hypertension, lack of physical activity or overweight), were randomized into two groups. The control group received standard treatment according to guidelines, the intervention group additionally received pro-active counseling and self-monitoring (pedometer, weighing scale and/ or blood pressure device). After one year treatment effect on 179 participants was analyzed. Results SCORE risk assessment decreased 1.6% (95% CI 1.0–2.2) for the control group and 1.8% (1.2–2.4) for the intervention group, difference between groups was .2% (−.6–1.1). Most risk factors tended to improve in both groups. The number of visits was higher and visits took more time in the intervention group (4.9 (SD2.2) vs. 2.6 (SD1.5) visits p < .001 and 27 (P25 –P75:20–33) vs. 23 (P25 –P75:19–30) minutes/visit p = .048). Conclusions In both groups cardiovascular risk decreased significantly after one year of treatment by practice nurses. No additional effect of basing the pro-active counseling on self-monitoring was found, despite the extra time investment. Trial registration trialregister.nl NTR2188
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Affiliation(s)
- Ans H Tiessen
- Department General Practice, University Medical Centre, Groningen, the Netherlands.
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240
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Middeke M. [Telemedicine in chronic heart failure: patient selection is a prerequisite for success]. Herz 2012; 37:81-4. [PMID: 22190192 DOI: 10.1007/s00059-011-3553-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The two biggest studies worldwide on telemedicine in chronic heart failure were conducted in Germany. The study design, patient selection and equipment as well as the mode of therapeutic intervention varied between the two studies as much as their outcomes. A comparison of the two studies allows conclusions to be drawn as regards achieving effective telemedical intervention in chronic heart failure. Patient age, medication and degree of heart failure and the telemedical program itself are decisive factors in attaining a successful approach. It is best to induct patients into the program after hospitalisation for decompensated heart failure, especially in cases where the maximum drug therapy could not be administered.
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Affiliation(s)
- M Middeke
- Hypertoniezentrum München, Hypertension Excellence Center of the European Society of Hypertension (ESH), Herzzentrum Alter Hof München, Dienerstr. 12, 80331, München, Deutschland.
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Walker A, Dastidar AG, Garg P. Cardiology day case unit: the way to manage chronic cardiovascular conditions cost-effectively in future. Clin Med (Lond) 2012; 12:398-9. [PMID: 22930896 PMCID: PMC4952140 DOI: 10.7861/clinmedicine.12-4-398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW This review will provide an overview of the recent advances in the management of chronic heart failure, with special focus on major publications in the past 2 years, 2010-2011. RECENT FINDINGS In the past 1-2 years, there have been a number of publications that promise to make a major difference in patient management and outcome in heart failure. These include two clinical trials in patients with less symptomatic heart failure, namely the use of cardiac resynchronization therapy (CRT) and eplerinone, an aldosterone receptor antagonist, and another study using ivabradine, which belongs to a new class of If channel blocking drugs used for heart rate reduction in patients with moderate heart failure. The evolving role of telemedicine in remote management of patients with heart failure is reviewed. SUMMARY New data demonstrate the benefit of CRT and aldosterone antagonists in milder heart failure, the benefit of ivabradine in moderate heart failure with heart rate of 70 or more, and the potential role of telemedicine.
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Jaarsma T, Brons M, Kraai I, Luttik ML, Stromberg A. Components of heart failure management in home care; a literature review. Eur J Cardiovasc Nurs 2012; 12:230-41. [PMID: 22707520 DOI: 10.1177/1474515112449539] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with heart failure (HF) need long-term and complex care delivered by healthcare professionals in primary and secondary care. Although guidelines on optimal HF care exist, no specific description of components that are applied for optimal HF care at home exist. The objective of this review was to describe which components of HF (home) care are found in research studies addressing homecare interventions in the HF population. METHODS The Pubmed, Embase, Cinahl, and Cochrane databases were searched using HF-, homecare services-, and clinical trial-related search terms. RESULTS The literature search identified 703 potentially relevant publications, out of which 70 articles were included. All articles described interventions with two or more of the following components: multidisciplinary team, continuity of care and care plans, optimized treatment according to guidelines, educational and counselling of patients and caregivers, and increased accessibility to care. Most studies (n=65, 93%) tested interventions with three components or more and 20 studies (29%) used interventions including all five components. CONCLUSIONS There a several studies on HF care at home, testing interventions with a variety in number of components. Comparing the results to current standards, aspects such as collaboration between primary care and hospital care, titration of medication, and patient education can be improved.
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McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GYH, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33:1787-847. [PMID: 22611136 DOI: 10.1093/eurheartj/ehs104] [Citation(s) in RCA: 3482] [Impact Index Per Article: 290.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GYH, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012. [DOI: 78495111110.1093/eurheartj/ehs104' target='_blank'>'"<>78495111110.1093/eurheartj/ehs104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1093/eurheartj/ehs104','', '10.1093/eurjhf/hfr039')">Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
78495111110.1093/eurheartj/ehs104" />
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Boyne JJJ, Vrijhoef HJM, Crijns HJGM, De Weerd G, Kragten J, Gorgels APM. Tailored telemonitoring in patients with heart failure: results of a multicentre randomized controlled trial. Eur J Heart Fail 2012; 14:791-801. [PMID: 22588319 DOI: 10.1093/eurjhf/hfs058] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. METHODS AND RESULTS A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32-93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan-Meier P = 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35-1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan-Meier P = 0.641, HR 0.89, 95% CI 0.69-1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann-Whitney P < 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann-Whitney P = 0.34, Cox regression analysis P = 0.82). CONCLUSION No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed. TRIAL REGISTRATION NCT00502255.
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Affiliation(s)
- Josiane J J Boyne
- Department of Patient & Care, Maastricht University Medical Centre, & CAPHRI, The Netherlands.
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Affiliation(s)
- Jo Morrison
- Musgrove Park HospitalDepartment of Obstetrics and GynaecologyTauntonUK
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Lyngå P, Persson H, Hägg-Martinell A, Hägglund E, Hagerman I, Langius-Eklöf A, Rosenqvist M. Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial. Eur J Heart Fail 2012; 14:438-44. [PMID: 22371525 DOI: 10.1093/eurjhf/hfs023] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS This multicentre, randomized controlled trial hypothesized that daily electronic transmission of body weight to a heart failure (HF) clinic will reduce cardiac hospitalization in patients recently hospitalized with HF. METHODS AND RESULTS A total of 344 patients were randomized to either an intervention group (IG) or a control group (CG). Of the 319 patients included in the final analysis, the mean age was 73 years (SD 10.2), 75% were males, and 57% had a left ventricular ejection fraction (LVEF) <30%. Patients in both groups were recommended to weigh themselves daily and, in the case of sudden weight gain >2 kg in 3 days, to contact the HF clinic. Patients in the IG were given an electronic scale and the weight was automatically transmitted to and monitored at the HF clinic. No significant differences were found for the primary endpoint, cardiac re-hospitalization [70/153 CG, 70/166 IG; hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.65-1.26, P = 0.54], or for the secondary endpoints, which included all-cause hospitalization (84/153 CG, 79/166 IG; HR 0.83, 95% CI 0.61-1.13, P = 0.24), death from any cause (8/153 CG, 5/166 IG; HR 0.57, 95% CI 0.19-1.73, P = 0.32), or the composite endpoint of cardiac hospitalization and death from any cause (78/153 CG, 75/166 IG; HR 0.90, 95% CI 0.65-1.26, P = 0.54). Subgroup analyses did not show any benefits for patients in the IG despite their more frequent monitoring; 398 occasions compared with 30 occasions in the CG. CONCLUSION Daily electronic transmission of body weight and monitoring three times a week did not decrease hospitalization or death in HF patients followed up at a HF clinic.
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Affiliation(s)
- Patrik Lyngå
- Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset and Department of Cardiology Södersjukhuset, Stockholm, Sweden.
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