Impact of Home Patient Telemonitoring on Use of β-Blockers in Congestive Heart Failure

Abstract

Congestive heart failure (CHF), which typically affects older people, is characterized by high short- and mid-term mortality rates. However, despite accumulating evidence showing that administration of β-blockers (β-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these agents in adequate dosages in this setting is not routine. One reason for this appears to be a concern about a possible risk of bradyarrhythmia associated with use of β-blockers. Telecardiology has recently been investigated as a means of constantly monitoring the heart rate of CHF patients in their homes. Its use may allay concerns about the risk of bradyarrhythmia and facilitate a more widespread use of β-blockers in this context. The primary objectives of this study were to assess the impact of telemonitoring on patients' adherence to prescribed therapeutic regimens, particularly β-blockers, and to explore whether use of home telemonitoring reduces mortality and rate of re-admission to hospital in elderly CHF patients compared with normal specialized CHF team care. A total of 57 patients with CHF (31 New York Heart Association [NYHA] class II, 23 NYHA class III and 3 NYHA class IV), with a mean ± SD age of 78.2 ± 7.3 years, were randomized to a control group who received standard care, based on routinely scheduled clinic visits, from a team specialized in CHF patient management, or to a home telemonitoring group (TM group), managed by the same specialized CHF team. Patients were followed up over 12 months. Compared with the control group, the TM group had a significant increase in the use of β-blockers, HMG-CoA reductase inhibitors (statins) and aldosterone receptor antagonists. A reduction in nitrate administration compared with baseline was also seen in the TM group. The 12-month occurrence of the primary combined endpoint of mortality and hospital re-admission for CHF was significantly lower in the TM group than in the control group (p < 0.01). This study showed that a home-care model including telemonitoring of relevant clinical parameters may provide useful support in the management of patients with CHF. Home telemonitoring in CHF patients was associated with increased use of β-blockers at appropriate doses, suggesting that this strategy reassured physicians regarding the safety of careful use of these agents in this setting. However, larger studies are required to confirm these findings. Our findings indicate that there is a need to investigate relevant parameters in CHF patients at the point of care (i.e. in patients' daily lives), which can in turn optimize β-blocker and other drug therapy.