Short 3-month telemedical monitoring is associated only with partial maintenance of functional performance 12 months later: a single-arm study in patients with heart failure in underserved areas

INTRODUCTION: A 3-month telemedical care model under specialist supervision was associated with an improvement in New York Heart Association (NYHA) class and quality of life in heart failure (HF) population from underserved areas. OBJECTIVES: This study sought to investigate whether the effects of a 3-month telemonitoring intervention (3m-INT) were maintained 12 months later. PATIENTS AND METHODS: In this prospective study, HF patients were enrolled in 5 rural voivodeships and were evaluated after completion of a 3m-INT and 12 months later using the NYHA scale, the Chronic Heart Failure Questionnaire (CHFQ) and the EuroQol Visual Analogue Scale. The clinical composite endpoint (CCE) was death, hospitalization for HF decompensation, stroke, or myocardial infarction. RESULTS: Of 429 HF patients who completed 3m-INT, 320 (74.6%) were reevaluated 12 months later. Within the 3m-INT, 1 patient died and 6 more during the following 12 months. After 12 months follow-up, CCE occurred in 23 (7.2%) patients while the NYHA class improved in 42 (13.4%) patients, remained unchanged in 131 (41.7%), and deteriorated in 141 (44.9%). Finally, the distribution of NYHA classes at 12 months remained significantly better than at baseline (P <0.001). Atrial fibrillation was independently associated with the occurrence of CCE (P = 0.005). EuroQol Visual Analogue Scale-assessed quality of life did not change (P = 0.36), while CHFQ-measured dyspnea measured by CHFQ deteriorated (P <0.001) after a 1-year observation. CONCLUSIONS: After 3m-INT followed by 12 months of observation, only partial maintenance of functional performance of HF patients in underserved areas was observed. Atrial fibrillation was associated with an unfavorable clinical effect.