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Telemedicine in heart failure is rapidly evolving.
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Evidence is conflicting, mainly due to a lack of uniform methods/systems.
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Direct comparison between different modalities is lacking which impedes determination of the most effective method.
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Telemedicine should evolve into more than an addition to standard of care.
Background
Current evidence
Implantable devices
Study | Design |
N
| FU in months | Intervention | Primary endpoint | Outcome |
---|---|---|---|---|---|---|
TELE-HF (2010) | RCT | 1,653 | 6 | TM: | readmission for any reason or death | negative |
2 arms: | telephone based interactive voice-response system. Symptoms and weight daily collected | (difference 0.8% points; 95% CI −4.0–5.6; p = 0.75) | ||||
TM vs. UC | ||||||
WISH (2010) | RCT | 344 | 12 | intervention group: | cardiac rehospitalisation | negative |
2 arms: | electronic scale automatically transmitted weight | (HR 0.90; 95% CI 0.19–1.73; p = 0.32) | ||||
TM vs. UC | ||||||
CHAMPION (2011) | prospective single blind multicentre trial | 550 | 15 | CardioMEMS: wireless implantable haemodynamic monitoring system of pulmonary artery pressures in addition of standard care | HF related hospitalisations | positive |
(HR 0.72; 95% CI 0.60–0.85; p = 0.002) | ||||||
2 arms: | ||||||
intervention vs. UC | ||||||
no device/system-related complications | positive | |||||
(98.6%; 95% CI 99.3–100.0) | ||||||
no pressure-sensor failure | positive | |||||
(100%; 95% CI 99.3–100.0) | ||||||
TIM-HF (2011) | RCT | 710 | 26 | TM: Including daily ECG, blood | mortality | negative |
2 arms: | pressure, body weight | (HR 0.97; 95% CI 0.67–1.41; p = 0.87) | ||||
TM + MTS vs. UC | ||||||
INH (2012) | open RCT | 715 | 6 | HF nurse: | combined: time to death or rehospitalisation | negative |
in hospital contact; teaching materials; UTS; blood pressure/heart rate; up-titrating medication (in cooperation with GPs); weekly contact first, later individualised | ||||||
2 arms: | (HR 1.02; 95% CI 0.81–1.30; p = 0.89) | |||||
NTS + UC vs. UC | ||||||
CHAT (2013) | RCT | 405 | 12 | TeleWatch system | composite of death; HF hospitalisation; withdrawal from study due to worsening HF and improvement of well-being | negative |
2 arms: | follow-up by HF nurses at least monthly regarding: HF clinical status; medical management; social relevant questions | (OR = 1.02; p = 0.91) | ||||
UC vs. UC + NTS | ||||||
IN-TIME (2014) | RCT | 664 | 12 | TM by ICD: | composite of all-cause death; overnight HF hospital admission; change in NYHA class and change patient self-assessment | positive |
2 arms: | Tachyarrhythmia; low % biv-pacing; increase VES; decreased patient activity; abnormal intracardiac electrogram | (OR 0.63; 95% CI 0.43–0.90) | ||||
UC + TM vs. UC | ||||||
MCCD (2014) | RCT | 204 | 26 | remote monitoring of: | 30-day readmission for the first year | positive |
2 arms: | daily weight; blood pressure; heart rate; heart rhythm | |||||
TM vs. UC | ||||||
all-cause hospitalisation; Average time to hospitalisation; Costs; Mortality and QoL | negative | |||||
EFFECT (2015) | prospective, non-randomised trial | 987 | 12 | TM by CIED: | combined: all-cause mortality and CV hospitalisations | positive |
study protocol did not mandate any specific device programming and was free to enable the available system integrity and clinical alerts for automatic remote notification | (0.15 vs. 0.27 events/year; incident rate ratio, 0.55; 95% CI, 0.41–0.73; p < 0.001) | |||||
2 arms: | ||||||
UC vs. TM + UC | ||||||
OptiLink HF (2016) | RCT | 1,002 | 22–23 | TM by CIED: | composite of all-cause death and CV hospitalisation | negative |
2 arms: | fluid status alerts; automatically transmitted as inaudible text message to the responsible physician | (HR 0.87; 95% CI 0.62–1.28; p = 0.52) | ||||
UC vs. TM + UC | ||||||
COMMIT-HF (2017) | observational prospective cohort study | 822 | 36 | TM by CIED: | all-cause mortality | positive |
automatic transmission of data from the cardiac device. Daily check of the data by 2 physicians and 2 EP nurses | ||||||
(HR 0.187; 95% CI 0.075–0.467, p = 0.0003) | ||||||
2 arms: | ||||||
US vs. TM + UC | ||||||
TIM-HF2 (2018) | RCT | 1,571 | Max 13 | daily transmission of: bodyweight; blood pressure; heart rate; heart rhythm; SpO2; Self-rated health status | percentage of days lost due CV hospitalisations or all-cause death | positive |
2 arms: | (ratio 0.80; 95% CI 0.65–1.00; p = 0.0460) | |||||
UC vs. UC + RPM |
Non-invasive monitoring
Dutch studies
Study | Design |
N
| FU in months | Intervention | Primary endpoint | Outcome |
---|---|---|---|---|---|---|
TEN-HMS study (2005) | RCT | 426 | 14–15 | TM: | TM vs. NTS: | negative |
3 arms: | electronic monitoring of weight; blood pressure; single lead ECG | days lost because of death or hospitalisation | (difference −4 days; CI −15–6) | |||
UC; TM; NTS | ||||||
NTS: (nursing telephone support) | TM, NTS vs. UC: | positive | ||||
days lost because of death or hospitalisation | (difference 6 days; 95% CI 1–11) | |||||
TEHAF (2010) | RCT | 382 | 12 | Health Buddy: | Time to first hospitalisation | negative |
2 arms: | Monitoring signs & symptoms; Education; Support of self-care | (HR 0.65; 95% CI 0.35–1.17; p = 0.151) | ||||
UC; TM | ||||||
IN TOUCH (2016) | RCT | 177 | 9 | innovative ICT-guided-disease management support combined with TM | composite endpoint of mortality, HF readmission and change in health-related quality of life | negative |
2 arms: | (Mean difference 0.1; 95% CI −0.67–0.82; p = 0.39) | |||||
innovative ICT-guided support; Innovative ICT-guided support + TM | ||||||
electronic monitoring of weight; blood pressure; ECG (used in case of start-up or up-titration of beta-blockers) | ||||||
e-Vita (2018) | RCT | 450 | 12 | heart Failure Matters website | self-care | negative |
3 arms: | care pathway on e‑vita platform | HFM vs. UC mean 72.1 vs. 72.7, and EACP vs. UC 76.1 vs. 72.7, respectively (overall p = 0.184) | ||||
UC; UC + HFM website; care pathway + link to HFM website | ||||||
Hart Motief Study (2015) | pre-post design | 102 | 12 | Motiva telehealth system: providing educational material, reminders of medication and motivational messages | no. of HF-hospitalisations | positive |
(rate ratio 4.1; 95% CI 2.8–6.3; p < 0.001) |