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European Society of Cardiology, Tim Kelleher

Clinical Articles, Lead Article

BENEFITS OF TELEMONITORING DEFINED

The precise populations of patients with chronic heart failure (HF) who could benefit from telemonitoring have been defined by two trials presented recently at the European Society of Cardiology’s (ESC) Heart Failure Congress 2011.

Both the TIM-HF1 (Telemedical Interventional Monitoring in Heart Failure) and TEHAF2 (Tailored Telemonitoring in Patients with Heartfailure) studies found that telemonitoring demonstrated significant benefits in defined subgroups of patients. These results, however, come after the overall results from both trials demonstrated no statistical benefit for telemonitoring.

In the TIM-HF trial investigators led by led by Dr Friedrich Koehler examined data from 710 stable patients with NYHA class II or III, left ventricular ejection fractions less than 35% and a history of HF decompensation.  Subjects were randomised to either a remote telemedical management system (n = 354) or to usual care (n = 356).  The telemedical system transmitted electrocardiogram (ECG), blood pressure, and body weight measurements directly to support centres on a daily basis, in addition to a landline-based personal emergency response system.

bosch telehealth (original)Results showed that at a median follow-up of 26 months remote telemonitoring management delivered no significant benefits compared to usual care on all-cause mortality (p = 0.87), or the composite end point of cardiovascular death and HF hospitalisation (p = 0.44).

The TIM-HF investigators undertook a second analysis exploring outcomes in pre-specified subgroups according to a variety of factors.  They found that for patients with a prior history of decompensation, no depression on the PH-Q depression score, and who had left ventricular ejection fractions above 25%, cardiovascular death was statistically less likely to occur in the group randomised to telemedicine monitoring than those randomised to usual care (p < 0.027).

There was also a statistically significant benefit for the group randomised to telemedicine for the number of days lost due to hospitalisation for HF and death (p < 0.005).  This information, said Koehler, forms the basis of a hypothesis which will be used to define the patient population in the TIM-HF II  study, due to start enrolment in Autumn 2011.

In the TEHAF study Josiane Boyne and colleagues, from Maastricht University Medical Centre (The Netherlands), investigated the effectiveness of a self-reporting based telemonitoring system in 382 patients with NYHA II-IV (197 allocated to the intervention group, 185 to usual care).  The Health Buddy® (Bosch) system allows patients to answer a set of questions daily through a button interface, their responses sent to caregivers for risk assessment through a protected server.

The latest subgroup analysis of the primary endpoint, presented at the Heart Failure Congress 2011, found that patients in the intervention group with HF durations of 18 months had a significant decrease in number of admissions for HF (p = 0.026). The subgroup analysis showed no such significant effects for patients who had HF duration > 18 months. Furthermore, for patients in the intervention group a significant decrease was found their face to face contacts with HF nurses (p < 0.001).

The results, say the authors, suggest that telemonitoring systems offer particular benefits for patients with HF duration of less than 18 months. “Our system is based on the hypothesis that more knowledge leads to better compliance and therefore less symptoms.  We therefore think that patients  diagnosed recently have  greater potentially to be influenced by the system than patients with longer histories of the condition who have already adapted their life styles,” said  Boyne.

She added that another possibility is that HF deteriorates with time, so that patients with longer duration may prove harder to treat. The observed decrease in contact with the HF nurse, she said, offers promise from the perspective of reducing future demands on the health care system.

References

1 Koehler F, Winkler S, Schieber M, et al.  Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. Eur J Heart Fail 2010;12:1354–62.

2 Gorgels APM, Vrijhoef BJM, Crijns HJGM, et al. The effects of a tailored telemonitoring system in patients with heart failure: The TEHAF-study. ESC Heart Failure 2011.

Published on: July 6, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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