Adding telemonitoring to an ICT-guided disease management system did not significantly improve the composite endpoint of mortality, heart failure readmission, and quality of life in patients with worsening heart failure.
RCT (n=177)
Open-label with blinded endpoint adjudication
Computer-generated random permuted blocks stratified by center
Yes
Does adding telemonitoring to an ICT-guided disease management system improve a composite of mortality, HF-readmission, and HR-QoL in chronic heart failure patients?
Adding telemonitoring to an ICT-guided disease management system in heart failure patients did not improve the composite of mortality, readmission, and quality of life, but significantly reduced HF-outpatient clinic visits.
Mean Difference: 0.1 (95% CI -0.67–0.82)
Absolute Event Rate: -0.73% vs -0.63%
p-value: p=0.39
AIM: It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. METHODS: A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). RESULTS: In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01). CONCLUSION: ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs.
Kraai et al. (Sun,) conducted a rct in Heart failure (n=177). ICT-guided disease management system with telemonitoring vs. ICT-guided disease management system alone was evaluated on Composite weighted score of mortality, HF-readmission, and change in HR-QoL (MD 0.1, 95% CI -0.67 to 0.82, p=0.39). Adding telemonitoring to an ICT-guided disease management system did not significantly improve the composite endpoint of mortality, heart failure readmission, and quality of life in patients with worsening heart failure.