Effects of remote patient management on self-care behaviour in heart failure patients: results from the TIM-HF2 trial

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote patient management (RPM) in heart failure (HF) patients is a rapidly developing field of digital cardiology with beneficial clinical effects. RPM might affect HF specific self-care behaviour, which represents an important patient-reported outcome. Purpose To investigate the effects of RPM used in the Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial on HF-specific self-care as a prespecified secondary endpoint analysis. Methods and Results HF patients who were recently hospitalized and do not suffer from major depression were randomized to either RPM plus Usual Care (UC) or UC only, with a 12-month follow-up. Self-reported self-care behaviour at baseline and study-end were assessed by mean differences of the 9-item European Heart Failure Self-care Behaviour Scale (EHFScBS-9). 1,538 HF patients (mean age 70.3±10.5 years, 70% men, 52% NYHA class II and 47% NYHA class III, 65% LVEF ≤45%) were included, obtaining 1,321 patients with valid baseline and follow-up questionnaires. Self-care behaviour 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 (mean difference 4.58 95% CI 3.02, 6.14; p<0.001). The subgroup of patients living alone and having an inadequate (<70) baseline self-care behaviour score showed the highest improvement (8.66[3.52; 13.81]). There were significant changes between both groups in item "I weight myself every day" (MD -1.13; 95% CI -1.24, -1.02; p<0.001), and item "I take my medication as prescribed" (MD -0.06; 95% CI -0.10, -0.01; p=0.014). No relation was found between the self-care behaviour score and the efficacy of RPM on the primary and main secondary endpoints of the TIM-HF2 study. Conclusions RPM improves HF-specific self-care behaviour by achieving a better adherence to recommended HF regimen. Clinical endpoints were not affected by the level of self-care behaviour.