Telemonitoring in Heart Failure Rehabilitation

2011 ◽  
Vol 7 (1) ◽  
pp. 66 ◽  
Author(s):  
Ewa Piotrowicz ◽  
Ryszard Piotrowicz ◽  
◽  

Exercise training (ET) is now recommended as an important component of a comprehensive approach to patients with heart failure (HF). Despite the existence of proven benefits of ET, many HF patients remain physically inactive. Introducing telerehabilitation (TR) may eliminate most of the factors that result in the currently low number of patients undergoing outpatient-based rehabilitation programmes and thus increase the percentage of those who will undergo cardiac rehabilitation. Despite the fact that TR is highly applicable and effective, there are few papers dedicated to the study of TR in HF patients. Until recently, only a couple of home rehabilitation-monitoring models have been presented, from the simplest, i.e. heart rate monitoring and transtelephonic electrocardiographic monitoring, through to the more advanced tele-electocardiogram (tele-ECG) monitoring (via a remote device) and realtime electrocardiographic and voice transtelephonic monitoring. It seems the last two are the most useful and reliable. Based on published studies, TR in HF patients could be equally effective as and provide similar improvements in health-related quality of life to standard outpatient cardiac rehabilitation. In addition, adherence to cardiac rehabilitation seems to be better during TR. Due to disease-related limitations, TR seems to be a viable alternative for comprehensive cardiac rehabilitation in HF patients. Further studies are needed to confirm the utility of this type of rehabilitation in routine clinical practice, including its cost-effectiveness. Because of the diversity of technological systems, it is necessary to create a platform to ensure compatibility between the devices used in telemedicine.

2011 ◽  
Vol 17 (9) ◽  
pp. 755-763 ◽  
Author(s):  
Rebecca L. Dekker ◽  
Terry A. Lennie ◽  
Nancy M. Albert ◽  
Mary K. Rayens ◽  
Misook L. Chung ◽  
...  

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Seongkum Heo ◽  
Debra K Moser ◽  
Terry A Lennie ◽  
Mary Fischer ◽  
Eugene Smith ◽  
...  

Background: Patients with heart failure (HF) have notably poor health-related quality of life (HRQOL), which is associated with high hospitalization rates. Physical symptoms have been associated with poor HRQOL. However, whether improvement in physical symptoms actually leads to improvement in HRQOL has not fully examined in patients with HF. Purpose: To examine the effects of changes in physical symptoms on changes in HRQOL at 12 months, after controlling for age, comorbidities, New York Heart Association (NYHA) functional class, and modifiable psychosocial and behavioral factors. Methods: Data on physical symptoms (Symptom Status Questionnaire-HF) and HRQOL (Minnesota Living with Heart Failure) were collected from 94 patients with HF (mean age 58 ± 14 years, 44% male, 58% NYHA functional class II/III) at baseline and 12 month follow-up. Age, comorbidities, and NYHA functional class were collected using standard questionnaires at baseline. Psychosocial variables (depressive symptoms [Patient Health Questionnaire], perceived control [Control Attitudes Scale-Revised], and social support [Multidimensional Scale of Perceived Social Support]) and behavioral variables (medication adherence [Micro-Electro-Mechanical Systems], sodium intake [24-hour urine], and self-care management [Self-care management subscale of the Self-Care of Heart Failure Index]) were collected at baseline. Hierarchical multiple regression analyses were used to analyze the data. Results: The mean score changes in physical symptoms and HRQOL were -3.8 (± 14.1) and -9.2 (± 24.1), respectively (negative scores indicate improvement.). Among the sociodemographic and clinical characteristics, psychosocial variables, behavioral variables, baseline physical symptoms, and changes in physical symptoms, only changes in physical symptoms predicted changes in HRQOL at 12 months (F = 6.384, R2 = .46, p < .001). Improvement in physical symptoms led to improvement in HRQOL. Conclusion: It is critical to improve physical symptoms to improve HRQOL. Thus, development and delivery of effective interventions targeting improvement in physical symptoms are warranted in this population.


2019 ◽  
Vol 26 (7-8) ◽  
pp. 452-461 ◽  
Author(s):  
Simon L Cichosz ◽  
Flemming W Udsen ◽  
Ole Hejlesen

Aim The aim of this study was to assess the impact on health-related quality of life (HRQoL) of a telehealth care solution compared with usual practice of patients with heart failure (HF). Methods A randomized controlled trial with a telehealth care solution (Telekit) as the intervention (with a focus on self-empowerment achieved by engaging patients in their own illness through self-monitoring) combined with usual care and usual care as the control. The primary outcome was a change in HRQoL as measured by the Short Form-36 (SF-36) questionnaire Physical Component Summary (PCS) score. Secondary outcomes were changes in HRQoL as measured by the SF-36 questionnaire Mental Component Summary (MSC) score and the HF disease-specific questionnaire Kansas City Cardiomyopathy Questionnaire 12 (KCCQ12) score, all of which were assessed from baseline to approximately 12 months’ follow-up between the two groups. Outcomes were assessed via unadjusted and adjusted analyses. Results At baseline, 299 (145 interventions, 154 controls) patients were enrolled. In the primary analysis ( n = 299), the adjusted intervention effects were PCS –0.81 (95% CI −2.7–1.1), MCS 4.66 (95% CI 1.8–7.5) and KCCQ12 3.67 (95% CI −0.7–8.1). Only the change in MCS was statistically significant. An unadjusted analysis replicated the primary analysis. Complete case analyses ( n = 193) generally resulted in a lower intervention effect on the PCS score, but the difference remained statistically insignificant. Conclusions Only the MCS score was significantly higher in the telehealth care group compared to the control group. ClinicalTrials.gov (NCT02860013), July 28, 2016


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