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      Telemonitoring in Chronic Heart Failure: A Systematic Review

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          Abstract

          Heart failure (HF) is a growing epidemic with the annual number of hospitalizations constantly increasing over the last decades for HF as a primary or secondary diagnosis. Despite the emergence of novel therapeutic approached that can prolong life and shorten hospital stay, HF patients will be needing rehospitalization and will often have a poor prognosis. Telemonitoring is a novel diagnostic modality that has been suggested to be beneficial for HF patients. Telemonitoring is viewed as a means of recording physiological data, such as body weight, heart rate, arterial blood pressure, and electrocardiogram recordings, by portable devices and transmitting these data remotely (via a telephone line, a mobile phone or a computer) to a server where they can be stored, reviewed and analyzed by the research team. In this systematic review of all randomized clinical trials evaluating telemonitoring in chronic HF, we aim to assess whether telemonitoring provides any substantial benefit in this patient population.

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          Most cited references36

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          The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications.

          Heart failure is a syndrome characterized initially by left ventricular dysfunction that triggers countermeasures aimed to restore cardiac output. These responses are compensatory at first but eventually become part of the disease process itself leading to further worsening cardiac function. Among these responses is the activation of the sympathetic nervous system (SNS) that provides inotropic support to the failing heart increasing stroke volume, and peripheral vasoconstriction to maintain mean arterial perfusion pressure, but eventually accelerates disease progression affecting survival. Activation of SNS has been attributed to withdrawal of normal restraining influences and enhancement of excitatory inputs including changes in: 1) peripheral baroreceptor and chemoreceptor reflexes; 2) chemical mediators that control sympathetic outflow; and 3) central integratory sites. The interface between the sympathetic fibers and the cardiovascular system is formed by the adrenergic receptors (ARs). Dysregulation of cardiac beta(1)-AR signaling and transduction are key features of heart failure progression. In contrast, cardiac beta(2)-ARs and alpha(1)-ARs may function in a compensatory fashion to maintain cardiac inotropy. Adrenergic receptor polymorphisms may have an impact on the adaptive mechanisms, susceptibilities, and pharmacological responses of SNS. The beta-AR blockers and the inhibitors of the renin-angiotensin-aldosterone axis form the mainstay of current medical management of chronic heart failure. Conversely, central sympatholytics have proved harmful, whereas sympathomimetic inotropes are still used in selected patients with hemodynamic instability. This review summarizes the changes in SNS in heart failure and examines how modulation of SNS activity may affect morbidity and mortality from this syndrome.
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            Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology.

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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
                Cardiol Res Pract
                Cardiol Res Pract
                CRP
                Cardiology Research and Practice
                Hindawi Publishing Corporation
                2090-8016
                2090-0597
                2012
                7 June 2012
                : 2012
                : 410820
                Affiliations
                1Department of Cardiology, Larissa University Hospital, P.O. Box 1425, 41110 Larissa, Greece
                2T.E.I. of Lamia, 35100 Lamia, Greece
                3Department of Radiology, Larissa University Hospital, 41110 Larissa, Greece
                4Military General Hospital, Larissa, Greece
                51st Department of Propaedeutic and Internal Medicine, Ethnikon and Kapodistriakon University School of Medical Sciences, Laikon Hospital, 11527 Athens, Greece
                61st Department of Medicine, AHEPA University Hospital, 31100 Thessaloniki, Greece
                7Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
                Author notes
                *Gregory Giamouzis: ggiamou@ 123456emory.edu

                Academic Editor: George Giannakoulas

                Article
                10.1155/2012/410820
                3375160
                22720184
                e5729a51-9423-4028-b104-8455a23c8b8e
                Copyright © 2012 Gregory Giamouzis et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 February 2012
                : 25 March 2012
                Categories
                Review Article

                Cardiovascular Medicine
                Cardiovascular Medicine

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