Telemonitoring of Outpatients With Heart Failure

Abstract

Heart failure (HF) remains a large medical problem, and prevention of decompensation and HF-related hospitalizations is important not only for the patient, but also from an economic point of view. Close monitoring is crucial and can be done through a whole spectrum of modalities. This monitoring ranges from a (nurse-based) disease management program, to structured telephone support, to remote or telemonitoring with or without the use of an implantable device.1–3 Article see p 2985 Disease management programs, usually with a specialized nurse and in the hospital, are implemented on a large scale, but the optimal level and intensity of care is still unclear.4 Structured telephone support may be useful, and a recent meta-analysis showed a reduction in HF hospitalization, but no effect on mortality.2 Remote, home, or telemonitoring using a number of (relatively simple) noninvasive variables such as heart rate, blood pressure, and body weight was also examined in a number of studies, and the same meta-analysis showed that this method reduced both hospitalizations and mortality.2 However, 2 recent large studies not included in that analysis did not show such a positive effect.5,6 In the American Telemonitoring to improve outcomes in HF (TELE-HF) study5 and in the German Telemedical Intervention Monitoring in HF (TIM-HF) study,6 which together randomly assigned 2362 HF patients, no effect on HF hospitalizations or mortality was observed. In recent years, a number of studies in the field of telemonitoring have been published that measured invasive variables. In the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of HF (COMPASS-HF) study,7 a strategy based on measurement of right-sided intracardiac pressures (with a special transvenous lead: Chronicle, Medtronic) was examined. The primary (composite) end point showed a nonsignificant 21% reduction, but there was a …