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      Remote Management of Heart Failure: An Overview of Telemonitoring Technologies

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          Abstract

          Technological advances have enabled increasingly sophisticated attempts to remotely monitor heart failure. This should allow earlier identification of decompensation, better adherence to lifestyle changes and medication and interventions (such as diuretic dosage changes) that reduce the need for hospitalisation. This review discusses telemonitoring approaches in heart failure, and the evidence for their impact. It is not difficult to collect data remotely, but converting more data into better decision-making that improves the outcome of care is challenging. Policy-makers and technology companies are enthusiastic about the potential of digital technologies to transform healthcare and bring expertise to the patient, rather than the other way round, but guideline writers are not yet convinced, due to the lack of consistent findings in randomised trials.

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          Most cited references21

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          Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial.

          It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization.
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            Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial.

            In the CHAMPION trial, significant reductions in admissions to hospital for heart failure were seen after 6 months of pulmonary artery pressure guided management compared with usual care. We examine the extended efficacy of this strategy over 18 months of randomised follow-up and the clinical effect of open access to pressure information for an additional 13 months in patients formerly in the control group.
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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.

              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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                Author and article information

                Journal
                Card Fail Rev
                Card Fail Rev
                CFR
                Cardiac Failure Review
                Radcliffe Cardiology
                2057-7540
                2057-7559
                24 May 2019
                May 2019
                : 5
                : 2
                : 86-92
                Affiliations
                Imperial College London London, UK
                Author notes

                Disclosure: MRC has received honoraria and grants from Abbott, Medtronic and Boston Scientific. DHB has received travel support from Abbott and Biotronik, and honoraria, travel support and a grant from Boston Scientific.

                Correspondence: Martin R Cowie, Clinical Cardiology, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK. E: m.cowie@ 123456imperial.ac.uk
                Article
                10.15420/cfr.2019.5.3
                6545972
                31179018
                d7e66f8d-46bc-488e-9417-c4457255000b
                Copyright © 2019, Radcliffe Cardiology

                This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

                History
                : 22 January 2019
                : 22 February 2019
                Page count
                Pages: 7
                Categories
                Clinical Practice

                remote monitoring,telemonitoring,heart failure,disease management,cardiac implantable electronic devices

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