A single centre study assessing the effectiveness of active monitoring, using telemedicine, in preventing heart failure admissions and death in a primary care population with systolic heart failure.
Abstract BackgroundPatients with systolic heart failure are at high risk of admission to hospital and death. This can be reduced by ensuring that they are receiving all evidence-based heart failure medications and by detecting early signs of deterioration in their condition.MethodsWe recruited 209 primary care patients with echocardiographically proven left ventricular systolic dysfunction (ejection fraction < 40%). 84 patients consented to be actively monitored by the heart failure team using telemedicine. 125 patients consented to receiving usual care but allowing access to their medical records. The primary end-point was cardiovascular death or admission to hospital for heart failure at 1 year. Secondary end-points included the prescription of evidence-based heart failure medications and patient satisfaction at the end of the study.ResultsThere was no difference in the mortality rate between the groups (6.02% in the active group and 5.56% in control). There was a significant difference in hospital admission (10.84% in the active group and 1.59% in control; p-value of 0.0078). At the end of the study, in the active group v control group, 92% v 52% of patients were on a beta-blocker, 92% v 48% on ACE-I/ARB, and 60% v 30% on an MRA. There were no differences in the final doses achieved.ConclusionsActive telemonitoring in an elderly population with systolic heart failure did not reduce cardiovascular mortality or admission to hospital for heart failure over the 1 year of the study. It did result in more patients receiving evidence based heart failure medications.Trial registrationThis trial received ethical approval from the Health Research Authority London-City Road and Hampstead Research Ethics Committee (REC Reference: 16/L0/0070, IRAS project ID: 173818). The ClinicalTrials.gov Identifier number is: NCT04371731. This trial was retrospectively registered on 30/4/2020 and this study adheres to CONSORT guidelines