Hang Ding, PhD; Sheau Huey Chen, PG; Iain Edwards, MBA; Rajiv Jayasena, PhD; James Doecke, PhD; Jamie Layland, MBChB, MD, PhD; Ian A Yang, MBBS, PhD, FRACP, FAPSR, FThorSoc, Grad Dip Clin Epid; Andrew Maiorana, PhD (2020). Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis. Journal of Medical Internet Research
Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.
Prof Friedrich Koehler, MD; Kerstin Koehler, MD; Sandra Prescher, MSc; Bridget-Anne Kirwan, PhD; Prof Karl Wegscheider, PhD; Eik Vettorazzi, MSc et al. (2019) Mortality and morbidity 1 year after stopping a remote patient management intervention: extended follow-up results from the telemedical interventional management in patients with heart failure II (TIM-HF2) randomised trial. The Lancet
The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial showed that, compared with usual care, a structured remote patient management (RPM) intervention done over 12-months reduced the percentage of days lost due to unplanned cardiovascular hospitalisations and all-cause death. The aim of the study was to evaluate whether this clinical benefit seen for the RPM group during the initial 12 month follow-up of the TIM-HF2 trial would be sustained 1 year after stopping the RPM intervention.
Remote patient management (RPM) promises to improve patient care.1 Previously, Friedrich Koehler and colleagues2 showed a significant benefit of RPM in patients with heart failure compared with usual care over a 12-month study period. Patients assigned to remote patient management lost a mean of 17·8 days (95% CI 16·6–19·1) per year due to unplanned cardiovascular hospitalisations and all-cause mortality compared with patients assigned to usual care who lost a mean of 24·2 days (22·6–26·0) per year. The authors now present the results of the extended 12-month follow-up period after stopping the RPM intervention.3 During this interval, there was no difference between RPM and usual care in the primary outcome, or recurrent heart failure hospitalisations and cardiovascular death. The authors concluded that the positive effect of RPM was lost when it was terminated, raising questions about the ideal duration of RPM for the patient group studied.
‘Despite favorable effects from telemedicine (TM) on cardiovascular diseases, outcome and comparative impact of TM on heart failure (HF) adults remain controversial. A meta-analysis was conducted to summarize the evidence from existing randomized controlled trials (RCTs) which compared potential impact of TM on HF with conventional healthcare. TM mainly included structure telephone support (STS), involving interactive vocal response monitoring and telemonitoring. A total of 29 RCTs consisting of 10,981 HF adults were selected for meta-level synthesis, with follow-up range of 1–36 months. Compared with conventional healthcare, telemedicine systems with medical support prove to be more effective for HF adults, particularly in reducing allcause hospitalization, cardiac hospitalization, all-cause mortality, cardiac mortality, and length of stay. While further research is required to confirm these observational findings and identify optimal telemedicine strategies and the duration of follow-up for which it confers benefits.’
‘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. 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.’
This thesis describes how nurses could be prepared with training and education to acquire telehealth competence.
Prof Friedrich Koehler, MD; Kerstin Koehler, MD; Oliver Deckwart, MScN; Sandra Prescher, MSc; Prof Karl Wegscheider, PhD; Bridget-Anne Kirwan, PhD et al. (2018) Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial; Lancet: volume 392, ISSUE 10152, P1047-1057, SEPTEMBER 22, 2018 https://doi.org/10.1016/S0140-6736(18)31880-4
Remote patient management in patients with heart failure might help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heart failure decompensation. We aimed to investigate the efficacy of our remote patient management intervention on mortality and morbidity in a well defined heart failure population.
‘Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone-based monitoring and videoconferencing, require further investigation.’
Gingele, A.J., Rocca, H.B., Ramaekers, B., Gorgels, A., Weerd, G., De, Kragten, J., Empel, V., Van, Brandenburg, V., Vrijhoef, H., Cleuren, G., Knackstedt, C. & Boyne, J., JJ. (2017) Telemonitoring in patients with heart failure: Is there a long-term effect? Journal of telemedicine and Telecare, 25(3) 158-166.
‘Evidence suggests that telemonitoring decreases mortality and heart failure (HF)-related hospital admission in patients with HF. However, most studies follow their patients for only several months. Little is known about the long-term effects of telemonitoring after a period of application. No significant difference in time to first HFrelated hospital admission, all-cause mortality, or DAOOH could be found. However, patients that underwent telemonitoring had significantly fewer HF-related hospital admissions.
Telemonitoring did not significantly influence the long-term outcome in our study. Therefore, extending the follow-up period of telemonitoring studies in HF patients is probably not beneficial.’
Hendy, J., Chrysanthaki, T., Barlow, J., Knapp, M., Rogers, A., Sanders, C., Bower, P., Bowen, R., Fitzpatrick, R., Bardsley, M. & Newman, S. (2012). An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator. BMC Health Serv Res. 12 403.
To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources. Conclusion: The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
‘Telebegeleiding laat een duidelijke trend zien in afnamen van het aantal ziekenhuisopnamen wegens hartfalen. Patiënten met een ziektegeschiedenis van korter dan 18 maanden hartfalen, hebben de beste resultaten. Tot slot hebben patiënten met telebegeleiding minder contacten met de hartfalenverpleegkundige. Deze uitkomsten geven aan dat telebegeleiding in staat is om ziekenhuisopnames te voorkomen en contacten met zorgverleners te verminderen.’
Domingo, e.a. (2011). Noninvasive Remote Telemonitoring for Ambulatory Patients With Heart Failure: Effect on Number of Hospitalizations, Days in Hospital, and Quality of Life. CARME (Catalan Remote Management Evaluation) Study. Revista española de cardiología. 64. 277-85.
‘The Motiva telemonitoring system significantly reduced the number of hospitalizations and days in hospital for HF and other cardiac causes in patients controlled in a structured multi- disciplinary HF unit. In order to determine which patients might benefit more from a particular telemonitoring system, a larger sample, allowing for subgroup analysis, is required. Finally, patients significantly improved their perceived QoL, particularly in the physical dimension.’