Background: Heart failure (HF) is a common, costly cause of hospitalization. Few studies have evaluated the long-term impact of electronic disease management (EDM) on HF care. We reported a mortality benefit among HF patients (pts) undergoing electronic daily weight assessment in the Weight Monitoring in Heart Failure (WHARF) trial. Using trial data on transplant-free survival, we evaluated whether the initial mortality benefit persisted after withdrawal of the EDM system.
Methods: 280 pts from 16 HF centers in the US were randomized, during admission for NYHA III/IV HF, to receive usual HF care or HF care and the AlereNet
TM
system (Alere Medical, Reno, NV). Pts were followed for 6 months prior to removal of the system. Transplant-free mortality data were then examined over the next 50 months.
Results: 138 pts received the EDM system and 142 received usual care. Mean age was 59+/−15 years; 68% male; 64% Caucasian; 75% had NYHA III HF. A 56.2% reduction in mortality was demonstrated for pts randomized to the EDM group (p<0.003). Continued Kaplan-Meier analysis, however, ultimately showed a withdrawal effect among those in this group. By approximately 8 months after removal of the EDM system, mortality rates between the groups were identical. In the early withdrawal phase, mortality among those removed from the technology appears higher. (Figure 1
)
Conclusions: The mortality benefit in the intervention arm did not persist on cessation of the EDM system. This withdrawal effect further supports the notion that technology-based weight monitoring offsets mortality among those with advanced HF. Additional research is warranted to determine the optimal duration of such EDM in HF care.
Bucindolol: A Pharmacogenomic Perspective on its Use in Chronic Heart Failure
