Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Telemonitoring was introduced with the potential to improve the medical care, quality of life and prognosis of patients with heart failure (HF). The aim of the study was to assess the effect of home telemedicine (HTM) in long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF).
Methods
This is a retrospective study of 452 consecutive subjects with HFrEF who were referred to HTM service. The HTM service was offered to HFrEF patients who: a) have been recently diagnosed with HF, b) have been recently hospitalized due to HF, c) have worsening HF, d) need frequent medication changes, e) are NYHA class II or III.
Most patients (n= 352) accepted HTM (HTM-group), but 100 patients refused and received the usual care (UC-group). The HTM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. A nurse practitioner evaluated the measurements every day using a dedicated clinical user interface. Clinical alerts are dealt with by the HTM nurse calling the patient and then, if necessary, a clinical responder; either a community HF nurse with prescribing qualifications or a cardiologist if long-term changes in therapy are required. Patients in both groups were seen at a specialist HF clinic and the frequency of clinical follow-up was at the discretion of the HF team. The same cardiologists reviewed the patients in both groups. Follow-up period was 60 months.
Higher prevalence of male gender was seen in the UC-group (78% vs 67%, p = 0.03). Otherwise there was no significant difference in the demographic characteristics or primary cause of HF between the two groups. Also no differences were seen between the two groups in the treatment with beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and aldosterone antagonists.
Results
The mean follow-up period for survivors was significantly higher in HTM-group compared with UC-group (50.6 ± 18.2 vs. 37.8 ± 25.2, p < 0.001). After 3 month of follow-up, the all-cause mortality was significantly lower in HTM-group than in UC-group (2.8% vs. 14%; p <0.01). This significantly lower mortality in HTM-group compared to UC-group was further observed in 6 months follow-up ( 4.5% vs. 22%, p < 0.0009); in 12 months follow-up (9% vs. 31.2%, p < 0.0002); in 18 months follow-up (13.4% vs. 38.2%, p < 0.0001); in 24 months follow-up (15.1% vs. 42%, p < 0.0001); in 36 months follow-up (19% vs. 44.5%, p < 0.0002); in 48 months follow-up (23% vs. 46%, p < 0.001); and finally in 60 months follow-up (25.3% vs. 46%, p < 0.003).
Conclusion
HTM was associated with improved survival. This was observed from the first months of the study and remained present until the end of the study.The reduced mortality in the HTM patients may reflect the fact that HTM improves patient HF knowledge and self-care behaviors.
Long-term Follow-Up of Patients with Heart Failure and Reduced Ejection Fraction Receiving Autonomic Regulation Therapy in the ANTHEM-HF Pilot Study
