Effects of Remote Patient Management on Self-Care Behaviour in Heart Failure Patients: Results from the randomised TIM-HF2 Trial.

Abstract

Remote patient management (RPM) in heart failure (HF) patients has beneficial clinical effects. This analysis investigates the effects of RPM used in the Telemedical Interventional Management in Heart Failure II trial on HF-specific self-care. From 2013 to 2017 1,538 HF outpatients (age 70.3±10.5years, 70% men, 52%/47% NYHA II/III, 65% LVEF ≤45%) with a recent HF hospitalisation were included to the study and randomised to Usual Care (UC) plus RPM (n=796) or UC only (n=775), with a 12-month follow-up. Self-reported self-care behaviour at baseline and at end of study was assessed with the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9), obtaining 1,321 patients with valid baseline and follow-up questionnaires for the analysis.EHFScBS-9 sum scores increased in the RPM group (n=667) from 78.7±17 to 84.5±14 and in the UC group (n=654) from 79.0±17 to 80.0±16 from baseline to 12 months (difference in means [MD] 4.58 [3.02, 6.14]; p<0.001) with highest improvement (8.66 [3.52; 13.81]) in patients living alone and having an inadequate (<70) baseline EHFScBS-9. There were differences between both groups in item "I weight myself every day" (MD -1.13 [-1.24, -1.02]; p<0.001), and item "I take my medication as prescribed" (MD -0.06 [-0.10, -0.01]; p=0.014). No correlation was found between the EHFScBS-9 score and the efficacy of RPM on the TIM-HF2 primary endpoint of percentage of days lost due to unplanned cardiovascular hospitalisation or death of any cause. RPM improves HF-specific self-care behaviour by achieving a better adherence to recommended HF regimen.