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      Impact of telemedical care and monitoring on morbidity in mild to moderate chronic heart failure.

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      Publication date:
      Journal: Radiology
      Keywords: Adult, Aged, Case-Control Studies, Confidence Intervals, Female, Follow-Up Studies, Germany, Heart Failure, diagnosis, mortality, therapy, Hospitalization, statistics & numerical data, Humans, Male, Middle Aged, Monitoring, Physiologic, methods, Pilot Projects, Probability, Prospective Studies, Severity of Illness Index, Statistics, Nonparametric, Stroke Volume, Survival Rate, Telemedicine, Time Factors, Treatment Outcome

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          Abstract

          We investigated in a pilot study whether telemedicine is beneficial in mild to moderate chronic heart failure. A total of 128 patients with an ejection fraction < or =60% and NYHA class II or III chronic heart failure were evaluated. Thirty-two patients were enrolled prospectively in a staged telemedical service program. Ninety-six controls were matched 3:1 to each telemedicine patient. Median follow-up was 307 days (range 104-459). All-cause hospitalization duration [317 vs. 693 days/100 patient years; relative risk (RR) 0.46; 95% confidence interval (CI) 0.37-0.58; p < 0.0001) and rate (38 vs. 77/100 patient years; RR 0.49; 95% CI 0.25-0.95; p = 0.034) as well as cardiac hospitalization duration (49 vs. 379 days/100 patient years; RR 0.13; 95% CI 0.08-0.23; p < 0.0001] were significantly lower, cardiac hospitalization rate (11 vs. 35/100 patient years; RR 0.31; 95% CI 0.11-1.02; p = 0.058) tended to be lower in the telemedicine compared with the control group. These preliminary data suggest that telemedical care and monitoring may reduce morbidity in patients with NYHA class II and III chronic heart failure. Copyright 2008 S. Karger AG, Basel.

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          Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study.

          Alan Rigby, Uwe Janssens, John Cleland … (2005)
          We sought to identify whether home telemonitoring (HTM) improves outcomes compared with nurse telephone support (NTS) and usual care (UC) for patients with heart failure who are at high risk of hospitalization or death. Heart failure is associated with a high rate of hospitalization and poor prognosis. Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises. Patients with a recent admission for heart failure and left ventricular ejection fraction (LVEF) 70 years, mean LVEF was 25% (SD, 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml (interquartile range 1,285 to 6,749 pg/ml). During 240 days of follow-up, 19.5%, 15.9%, and 12.7% of days were lost as the result of death or hospitalization for UC, NTS, and HTM, respectively (no significant difference). The number of admissions and mortality were similar among patients randomly assigned to NTS or HTM, but the mean duration of admissions was reduced by 6 days (95% confidence interval 1 to 11) with HTM. Patients randomly assigned to receive UC had higher one-year mortality (45%) than patients assigned to receive NTS (27%) or HTM (29%) (p = 0.032). Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure.
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            Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial.

            Amy Levin, B Fridlund, U Dahlström … (2003)
            The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge. A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2-3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family. There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01). Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.
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              Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET.

              Karl Swedberg, Lars Olsson, Andrew Charlesworth … (2005)
              Atrial fibrillation is common in patients with chronic heart failure (CHF). We analysed the risk associated with atrial fibrillation in a large cohort of patients with chronic heart failure all treated with a beta-blocker. In COMET, 3029 patients with CHF were randomized to carvedilol or metoprolol tartrate and followed for a mean of 58 months. We analysed the prognostic relevance on other outcomes of atrial fibrillation on the baseline electrocardiogram compared with no atrial fibrillation and the impact of new onset atrial fibrillation during follow-up. A multivariate analysis was performed using a Cox regression model where 10 baseline covariates were entered together with study treatment allocation. Six hundred patients (19.8%) had atrial fibrillation at baseline. These patients were older (65 vs. 61 years), included more men (88 vs.78%), had more severe symptoms [higher New York Heart Association (NYHA) class] and a longer duration of heart failure (all P<0.0001). Atrial fibrillation was associated with significantly increased mortality [relative risk (RR) 1.29: 95% CI 1.12-1.48; P<0.0001], higher all-cause death or hospitalization (RR 1.25: CI 1.13-1.38), and cardiovascular death or hospitalization for worsening heart failure (RR 1.34: CI 1.20-1.52), both P<0.0001. By multivariable analysis, atrial fibrillation no longer independently predicted mortality. Beneficial effects on mortality by carvedilol remained significant (RR 0.836: CI 0.74-0.94; P=0.0042). New onset atrial fibrillation during follow-up (n=580) was associated with significant increased risk for subsequent death in a time-dependent analysis (RR 1.90: CI 1.54-2.35; P<0.0001) regardless of treatment allocation and changes in NYHA class. In CHF, atrial fibrillation significantly increases the risk for death and heart failure hospitalization, but is not an independent risk factor for mortality after adjusting for other predictors of prognosis. Treatment with carvedilol compared with metoprolol offers additional benefits among patients with atrial fibrillation. Onset of new atrial fibrillation in patients on long-term beta-blocker therapy is associated with significant increased subsequent risk of mortality and morbidity.
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                Author and article information

                Journal
                PubMed ID:: 18376125
                DOI:: 10.1159/000119701

                ScienceOpen disciplines: Chemistry
                Keywords: Adult,Aged,Case-Control Studies,Confidence Intervals,Female,Follow-Up Studies,Germany,Heart Failure,diagnosis,mortality,therapy,Hospitalization,statistics & numerical data,Humans,Male,Middle Aged,Monitoring, Physiologic,methods,Pilot Projects,Probability,Prospective Studies,Severity of Illness Index,Statistics, Nonparametric,Stroke Volume,Survival Rate,Telemedicine,Time Factors,Treatment Outcome
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                ScienceOpen disciplines: Chemistry
                Keywords: Adult, Aged, Case-Control Studies, Confidence Intervals, Female, Follow-Up Studies, Germany, Heart Failure, diagnosis, mortality, therapy, Hospitalization, statistics & numerical data, Humans, Male, Middle Aged, Monitoring, Physiologic, methods, Pilot Projects, Probability, Prospective Studies, Severity of Illness Index, Statistics, Nonparametric, Stroke Volume, Survival Rate, Telemedicine, Time Factors, Treatment Outcome

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