If home telemonitoring reduces mortality in heart failure, is this just due to better guideline-based treatment?

Dierckx, R., Cleland, J. G.F. , Pellicori, P. , Zhang, J., Goode, K., Putzu, P., Boyalla, V. and Clark, A. L. (2015) If home telemonitoring reduces mortality in heart failure, is this just due to better guideline-based treatment? Journal of Telemedicine and Telecare, 21(6), pp. 331-339. (doi: 10.1177/1357633X15574947) (PMID:25766855)

Abstract

To investigate, in a ‘real-world’ setting, the impact of home telemonitoring (HTM) compared to usual care on achieved dose of guideline-recommended medication, hospitalisation rate and mortality in patients with heart failure (HF). Methods: We retrospectively analyzed data on 333 patients with HF referred to a HTM service supported by a nurse-specialist (mean age 7112 years, mean left ventricular ejection fraction (LVEF) 36 11% and median N-Terminal pro B-type Natriuretic Peptide (NT-proBNP) 2,972 ng/L (interquartile range (IQR): 1,447–7,801 ng/L)). Most patients (n ¼ 278) accepted HTM (HTM-group) but 55 refused and received usual care (UC-group). In the HTM-group, weight, heart rate, blood pressure and symptom severity were measured daily. Results: At referral, respectively 90%, 90%, 67% and 94% of patients with LVEF 440% (n ¼ 229) were treated with b-blockers (BB), angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA) and diuretics, with rates similar between groups. After 6 months, prescription of BB (92% vs 83%), ACE-I/ARB (92% vs 90%) and MRA (68% vs 67%) did not differ significantly between groups. The proportions of patients who achieved 550% and 5100% of target doses of BB, ACE-I/ARB and MRA were also similar in each group. However, during a median follow-up of 1094 days (IQR 767–1419) fewer patients who chose HTM died (33% vs 49%; P ¼ 0.002). Conclusion: Patients who choose HTM have a better prognosis than those who do not but this does not appear to be mediated through greater prescription of key HF medications.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John and Pellicori, Dr Pierpaolo
• Authors: Dierckx, R., Cleland, J. G.F., Pellicori, P., Zhang, J., Goode, K., Putzu, P., Boyalla, V., and Clark, A. L.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Journal of Telemedicine and Telecare
• Publisher: SAGE Publications
• ISSN: 1357-633X
• ISSN (Online): 1758-1109
• Published Online: 11 March 2015