Telemedicine In Heart Failure Research Articles

Which heart failure patients benefit most from non-invasive telemedicine? An overview of current evidence and future directions.

Telemedicine in heart failure (HF) management may positively impact health outcomes, but varied effects in studies hinder guidance in HF guidelines. Evidence on the effectiveness of telemedicine in HF subpopulations is limited. We conducted ascoping review to evaluate and synthesise evidence on the effectiveness of telemedicine across HF subpopulations that could guide telemedicine strategies in routine practice. Meta-analyses concerning randomised controlled trials (RCTs) with subgroup analyses on telemedicine effectives were identified in PubMed. We identified 15RCTs, encompassing 21different subgroups based on characteristics of HF patients. Findings varied across studies and no definite evidence was found about which patients benefit most from telemedicine. Subgroup definitions were inconsistent, not always apriori defined and subgroups contained few patients. Some studies found heterogeneous effects of telemedicine on mortality and hospitalisation across subgroups defined by: New York Heart Association (NYHA) classification, previous HF decompensation, implantable device, concurrent depression, time since hospital discharge and duration of HF. Patients represented in the RCTs were mostly male, aged 65-75years, with HF with reduced ejection fraction and NYHA classII/III. Traditional RCTs have not been able to provide clinicians with guidance; continuous real-world evidence generation could enhance monitoring and identify who benefits from telemedicine.

RELEASE-HF study: a protocol for an observational, registry-based study on the effectiveness of telemedicine in heart failure in the Netherlands

IntroductionMeta-analyses show postive effects of telemedicine in heart failure (HF) management on hospitalisation, mortality and costs. However, these effects are heterogeneous due to variation in the included HF population, the...

Telemedicine in Heart Failure in the COVID-19 and Post-Pandemic Era: What Have We Learned?

Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in HF and forcing the systems to be reorganised with the implementation and development of telemedical technologies. The main challenges for HF patients during the pandemic could be solved with new technologies aimed to limit the risk of SARS-CoV-2 transmission, optimise and titrate the therapy, prevent the progression and worsening of HF, and monitor patients with acute HF events in the course of and after COVID-19. Dedicated platforms, phone calls or video conferencing and consultation, and remote non-invasive and invasive cardiac monitoring became potential tools used to meet the aforementioned challenges. These solutions showed to be effective in the model of care for patients with HF and undoubtedly will be developed after the experience of the pandemic. However, the multitude of possibilities requires central coordination and collaboration between institutes with data protection and cost reimbursement to create effective mechanisms in HF management. It is crucial that lessons be learned from the pandemic experience to improve the quality of care for HF patients.

Telemedicine in cardiology - what is new?

There is robust evidence for the clinical efficacy of telemedicine in heart failure (HF) patients to reduce mortality and morbidity. For the first time, the Federal Joint Committee (G-BA) has approved telemedicine for HF patients as a digital method of care for a well-defined heart failure population. Patients with HF and a reduced left ventricular ejection fraction (LVEF ) < 40 % are now eligible for telemonitoring in a real-world settings of out-patient care in Germany. The implementation of telemedicine in the German health care system is a complex process including the introduction of telemedical technologies, educational programs for the patients as well as the implementation of standard operating procedures (SOPs) for the staff of telemedical centers. The ongoing research in telemedicine in HF patients is focusing on three issues: a) research to extend the suitable HF-population for telemonitoring; b) research on new telemedical sensor technologies, e.g. a new pulmonary pressure measurement system (Cordella) and a system for wireless measurement of left atrial pressure (V-LAP); c) the introduction of methods of artifical intelligence (AI), e.g. the AI-based speech analysis using a smart phone to characterize the pulmonary fluid status.

Telemonitoring of patients after COVID-19 hospitalization: study design and baseline characteristics

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study is part of the research and development project “Telemed50000” and is supported by the German Federal Ministry of Economic affairs and Climate Action on the basis of a decision by the German Bundestag. Background There is a robust evidence about the beneficial effects of telemedicine in heart failure (HF) patients causing an implementation process of this method of digital care in the health care systems of several European countries. It remains unclear whether it’s feasible to prevent complications of pre-existing comorbidities as well as detecting the onset of other clinical complications after discharge due to COVID-19 using telemonitoring on a daily basis. Purpose The primary endpoint of this study is to detect unplanned clinical events during a one year follow-up after hospitalization due to COVID-19 with a standard non-invasive telemonitoring system used for HF patients. The definition of unplanned clinical event includes: telemedical emergency interventions, admission to emergency room, unplanned hospitalization and all-cause death. Methods and study design Inclusion criteria were age ≥18 years and a PCR- positive Sars-CoV-2 infection with acute respiratory symptoms requiring hospitalization. The follow-up period was one year with a clinical onsite visit at baseline, a telemedical visit after 6 months (phone-call) and a final onsite visit after 12 months. Recruitment took place from February 2021 until February 2022 at 5 hospitals located in 3 different federal states across Germany (Figure 1). The telemedical system, including 5 telemedical devices, was installed at the patient´s home during a nurse-led visit (n=83) or it was installed by themselves, video-guided, after sending the telemedical equipment by a parcel service (n=26). The daily transferred vital parameter, included body weight, systolic and diastolic blood pressure, pulse rate, a three channel electrocardiogram (ECG) and peripheral capillary oxygen saturation (SPO2). A 2-miutes voice recording of standardized text was required once a week. Data were sent to a telemedicine centre (TMC). All parameters were reviewed by physicians and nurses of the TMC from Monday to Friday (8 am to 4 pm). A six minutes walking test (6MWT) was performed during the nurse led home visit at baseline (n=37), if the patients were able to do the test. A second 6MWT was required at final visit. Health-related quality of life was measured by the Patient Reported Outcomes Measurement Information System (PROMIS)-29 questionnaire at baseline, after 6 and 12 months. Telemedical interventions were only initiated in case of a life-threatening emergency. Conclusions The established telemedical approach for HF patients, is also an appropriate tool to investigate the long-term recovery process, in particular to detect systemic sequelae in a cohort of COVID-19 patients. The Telemed-COVID-19 trial will provide prospective epidemiological data about the frequency of unplanned clinical events after hospitalization due to COVID-19 because of the daily telemedical transfer of vital parameters.

Využití telemedicíny u pacientů se srdečním selháním

Chronic heart failure (HF), like any chronic disease, is a medical and socioeconomic burden. The number of patients with HF is increasing and our effort is to apply the most effective way of care in practice, preferably together with using telemedicine. Early diagnosis, therapy establishment and reduction of rehospitalizations play the key role in HF management. For patients for whom we add telemedicine (telephone consultation, physiological data transfer, data transfer from implantable devices, teleconsultation) and especially if we are able to provide the background of a well-functioning telemedicine center that is able to respond promptly to the data, we can recognize and respond to the deterioration in health status in a timely manner. Telemedicine has benefit in all aspects of care mentioned above, but mostly in the reduction of re-hospitalizations, which is related to the reduction of morbidity and mortality. Telemedicine in HF is also cost-effective.

The effect of telemedicine in heart failure based on frailty phenotypes

Heart failure (HF) is a disease of the elderly. In people aged>65years, it is the most common cause of rehospitalisations [1]. Nearly half of the patients diagnosed with HF will be frail (44.5%, 95% CI, 36.2%–52.8%) [2]. Not only is the prevalence of frailty high in HF patients, older persons with frailty are also at increased risk of developing new onset HF [3]. However, frailty is not only associated with the elderly as it can also occur in younger persons (aged <60 years) with HF [3]. The presence of frailty in HF patients accelerates disease progression of HF and increases their risk of rehospitalisation, mortality and functional decline at one year [4].

Virtual visits in cardiovascular disease: a rapid review of the evidence

Given the high prevalence of cardiovascular disease (CVD) in Canada and globally, as well as the staggering cost to human life and health systems, there is an urgent need to understand the successful applications of telemedicine in cardiovascular medicine. While telemedicine in cardiology is well documented, reports on virtual care in the form of synchronous, real-time communication between healthcare providers and patients are limited. As a result of the immediate suspension of ambulatory services for cardiology in Alberta, Canada, due to the Coronavirus Disease 2019 pandemic, we undertook a rapid review on the impact of non-virtual visits in cardiovascular ambulatory settings on patients’ healthcare utilization and mortality. Evidence from 12 randomized control trials and 7 systematic reviews was included in the rapid review, with the majority of papers (n = 15) focusing on telemedicine in heart failure. Based on our appraisal of evidence from the last 5 years, virtual visits are non-inferior, or more effective, in reducing hospitalizations and visits to emergency departments in patients with CVD compared to traditional standard in-clinic/ambulatory care. The evidence for a superior effect of virtual visits in reducing mortality was not supported in this review. While telemedicine is an appropriate tool for CVD follow-up care, more research into the efficacy of different components of telemedicine and virtual visits is required.

Remote monitoring and telemedicine in heart failure: implementation and benefits.

Purpose of reviewRemote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of heart failure (HF) patients. Aim of this article is to critically review recent findings on RM, highlighting potential benefits and barriers to its implementation.Recent findingsDevice-based RM is useful in the early detection of CIEDs technical issues and cardiac arrhythmias. Moreover, RM allows the continuous monitoring of several patients' clinical parameters associated with impending HF decompensation, but there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations.SummaryImplementation of RM strategies, together with a proactive physicians' attitude towards clinical actions in response to RM data reception, will make RM a more valuable tool, potentially leading to better outcomes.

Telemedicine in heart failure

Improved outpatient care of heart failure patients is considered crucial to avoiding unplanned cardiovascular hospitalizations and reducing mortality. Making up for regional and rural differences in heart failure care poses a further challenge. Telemedical care as a supplement to outpatient point-of-care medicine by the general practitioner and medical specialist is considered relevant to implementing this goal. This article presents the technical and organizational basics of telemedical methods in outpatient heart failure care. Current evidence on the efficacy of telemedical co-management is also explained based on the results from the nine most important randomized studies on telemedicine in heart failure. Particular attention is paid to the TIM-HF2 study published in 2018, which showed the superiority of telemedical co-management in terms of mortality and morbidity following recent hospitalization for heart failure. Pre-stratified subgroup analysis revealed no significant interactions in terms of the primary endpoint between urban and rural regions. Scalability is required in order to translate the telemedical study concept from TIM-HF2 to a nationwide care program for all patients in Germany. Telemed5000 is the first project to set its goal as the development of a telemedicine center for the telemedical co-management of up to 5000 patients using artificial intelligence. It is being funded by the Federal Ministry of Economics and Technology for the period 2019-2022.

Telemedicine in heart failure-more than nice to have?

Telemedicine in chronic diseases like heart failure is rapidly evolving and has two important goals: improving and individualising care as well as reducing costs. In this paper, we provide a critical and an updated review of the current evidence by discussing the most important trials, meta-analyses and systematic reviews. So far, evidence for the CardioMEMS device is most convincing. Other trials regarding invasive and non-invasive telemonitoring and telephone support show divergent results, but several meta-analyses and systematic reviews uniformly reported a beneficial effect. Voice-over systems and ECG monitoring had neutral results. Lack of direct comparison between different modalities makes it impossible to determine the most effective method. Dutch studies showed predominantly non-significant results, mainly due to underpowered studies or because of a high standard of usual care. There are no conclusive results on cost-effectiveness of telemedicine because of the above shortcomings. The adherence of elderly patients was good in the trials, being essential for the compliance of telemedicine in the entire heart failure population. In the future perspective, telemedicine should be better standardised and evolve to be more than an addition to standard care to improve care and reduce costs.

Home Telemedicine in Heart Failure: A Pilot Study of Integrated Telemonitoring and Virtual Provider Appointments.

Congestive heart failure is a significant cause of hospitalization, rehospitalization, and death. Reducing hospital readmission rates is a national priority. Various telemonitoring devices and programs have been developed to help meet this goal. The Health Connect system incorporates monitoring of physiologic data with regular virtual provider appointments. The Health Connect system integrates traditional telemedicine with virtual provider appointments. Virtual appointments empower patients to advocate for their own health by providing numerous opportunities for education and feedback. In addition to early identification of impending decompensation, virtual appointments allow providers to address noncompliance, which is a major factor driving poor outcomes. Further research is required to confirm the benefit of the Health Connect system.

Telemedicine in heart failure: Pre-specified and exploratory subgroup analyses from the TIM-HF trial

BackgroundMeta-analyses have suggested that remote telemedical management (RTM) positively affects clinical outcomes in chronic HF patients. The results of two recent randomised RTM trials do not corroborate these results. We aim to report prospectively defined and exploratory subgroup analyses for the TIM-HF trial and to identify a patient profile that could potentially benefit from RTM for further investigation in randomised clinical trials. MethodsIn TIM-HF, 710 stable chronic HF patients, in NYHA class II or III with a history of HF decompensation within 2years previously or a LVEF≤25% were randomly assigned (1:1) to RTM or usual care. The primary outcome was total death and secondary outcomes included days lost due to death or HF hospitalisation and a composite of cardiovascular death and HF hospitalisation. Twelve subgroups were prospectively defined and patient profiling was investigated for the subgroup with a prior history of HF decompensation, an LVEF≥25% and a PHQ-9 score<10. ResultsThe subgroup treatment effects were significant for total mortality for the PHQ-9 subgroup only (p for interaction<0.027). For the outcome ‘number of days lost due to hospitalisation for HF or death’, the subgroup treatment effects were significant (p for interaction<0.05) for patients with a prior HF decompensation or an ICD implant or a PHQ score of <10 and for the patient-profiling subgroup. ConclusionsTelemedicine management may not be appropriate for all HF patients. Future research needs to investigate which HF population may benefit from this intervention.