Abstract
Introduction: Introduced in 2007 by the Ontario Telemedicine Network, the Telehomecare program provides monitoring of patient’s parameters and coaching sessions. To date, no study evaluated the effect of Telehomecare on patient clinical monitoring parameters in Ontario. Hypothesis: We hypothesized that blood pressure (BP) would be improved among heart failure patients participating in the Telehomecare. Methods: We applied a time series study design to analyze patients’ BP values, transmitted via telemonitoring devices on a daily basis. The cohort included heart failure patients enrolled in the Telehomecare program from July 2012 to July 2015. The outcome of interest was the change in average (biweekly) systolic and diastolic BP levels over the 6-month program duration. The baseline BP levels were defined as the average of daily measurements for the first 2-week period after enrolment. Data was analysed by repeated measures with generalized linear mixed model procedures in SAS. Sensitivity analyses were conducted for per-protocol cohort, defined as those who had fully completed 6-month program duration. Results: Overall we analyzed data for 2186 heart failure patients (50% women) with average age of 76.0±11.4 years. At baseline, the systolic and diastolic BP levels were 129.2 ±19.8 and 70.4 ±12.7 mm Hg respectively. Over 6-month period systolic BP decreased by -3.5 mm Hg (95% CI: -4.2 to -2.8) and diastolic by -2.5 mm Hg (95% CI: -3.0 to -2.0). At baseline, one third of the patients (n=721) had elevated BP with an average systolic BP of 150.9±10.15 mm Hg and diastolic BP of 78.3±14.1 mm Hg. In a subgroup analyses of this population the reduction in systolic BP was -12.3 mm Hg (95% CI: -13.4 to -11.1) and in diastolic BP was -6.9 mm Hg (95% CI: -7.8 to -6.0) adjusted for age and gender. Similar changes were observed in per-protocol cohort. Conclusions: The systolic and diastolic BP levels significantly decreased in patients with heart failure enrolled in the Telehomecare program. These changes were more pronounced in patients with uncontrolled BP at program entry. Hence Telehomecare program might be a promising tool to help patients in BP management
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