Why the study?
Heart failure causes frequent hospital admissions, but the role of signs and symptoms in monitoring outpatients to identify risk for clinical deterioration remains unclear.
Do specific signs and symptoms assessed via a web-based telemonitoring application predict adverse events in heart failure outpatients?
Do specific signs and symptoms assessed via a web-based telemonitoring application predict adverse events in heart failure outpatients?
Regular assessment of non-classical signs and symptoms, such as anxiety and struggle with daily activities, alongside traditional symptoms like peripheral edema, can help identify heart failure patients at risk for clinical deterioration.
Answers are grounded in this paper and cite their sources.
Associated symptoms may aid telehealth risk stratification in HF outpatients; hypothesis-generating for prospective validation before practice change.
INTRODUCTION: Heart failure is a serious burden on health care systems due to frequent hospital admissions. Early recognition of outpatients at risk for clinical deterioration could prevent hospitalization. Still, the role of signs and symptoms in monitoring heart failure patients is not clear. The heart failure coach is a web-based telemonitoring application consisting of a 9-item questionnaire assessment of heart failure signs and symptoms and developed to identify outpatients at risk for clinical deterioration. If deterioration was suspected, patients were contacted by a heart failure nurse for further evaluation. METHODS: Heart failure coach questionnaires completed between 2015 and 2018 were collected from 287 patients, completing 18,176 questionnaires. Adverse events were defined as all-cause mortality, heart failure- or cardiac-related hospital admission or emergency cardiac care visits within 30 days after completion of each questionnaire. Multilevel logistic regression analyses were performed to assess the association between the heart failure coach questionnaire items and the odds of an adverse event. RESULTS: No association between dyspnea and adverse events was observed (odds ratio 1.02, 95% confidence interval 0.79-1.30). Peripheral edema (odds ratio 2.21, 95% confidence interval 1.58-3.11), persistent chest pain (odds 2.06, 95% confidence interval 1.19-3.58), anxiety about heart failure (odds ratio 2.12, 95% confidence interval 1.44-3.13), and extensive struggle to perform daily activities (odds ratio 2.23, 95% confidence interval 1.38-3.62) were significantly associated with adverse outcome. DISCUSSION: Regular assessment of more than the classical signs and symptoms may be helpful to identify heart failure patients at risk for clinical deterioration and should be an integrated part of heart failure telemonitoring programs.
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Gingele et al. (2021) studied this question.
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