Abstract 17680: A Comparison of Primary Care, Home-Based Telemonitoring, Telemonitoring with Video, or Specialist Directed Heart Failure Clinic Care for Patients with High Risk Heart Failure

Abstract

Introduction: Most studies of telephone-based care for heart failure (HF) patients have not integrated primary care providers at the initial point of care. Further, the addition of video assessment to telemonitoring has not been studied. We aimed to evaluate, in heart failure outpatients, the safety and feasibility of a telephone-based monitoring system with involvement of primary care providers compared to the gold-standard heart failure clinic model. Methods: Patients with a heart failure and at least one hospitalization within the previous six months were randomized in a 1:1:1 fashion to either usual care in a nurse-managed heart failure clinic with cardiologist backup (UC), or a daily telemonitoring system, with standard phone (TM) or video (TV) capability. The latter two groups additionally underwent biweekly scripted telephone (TM) or videophone (TV) calls. Protocol-based interventions with involvement of primary care provider were utilized. The primary outcome was the composite total mortality and hospitalization at 12 months follow up. Results: There were 122 patients (44 to UC, 38 to TM and 40 to TV), with 100% follow up. The median age was 67 years, 35% were female, mean EF was 46% and median NT-pro-BNP was 2211 pg/ml. The primary endpoint of occurred in 40 (or 33%) of patients and was not different between the three groups (UC 14, TM 12, and TV 14 events respectively, p= 0.81). Additionally, no difference in death (UC 4, TM 2, TV 4, p= 0.65) or total hospitalitzations were seen (UC 20, TM 17, TV 21, p= 0.75). Conclusions: A home telemonitoring strategy with primary care provider involvement appears to be a safe and feasible alternative to care in a specialist led heart failure clinic for patients with ambulatory heart failure. The addition of video capability is unlikely to provide a major impact. Further, properly powered studies are justified in order to establish the relative benefits of this strategy as a routine treatment modality for heart failure.