What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic Heart Failure (n=414). Intervention: Interventional specialized telemonitoring vs. Standard telemonitoring and standard of care. Primary outcome: Unplanned hospitalization (OR 0.303, 95% CI 0.165-0.555, p=<0.001).

July 14, 2022Open Access

Benefits of Interventional Telemonitoring on Survival and Unplanned Hospitalization in Patients With Chronic Heart Failure

Q: What are the key findings of this study?

Interventional specialized telemonitoring significantly reduced the odds of unplanned hospitalization (OR 0.303) and all-cause mortality (OR 0.255) compared to standard care in patients with chronic heart failure.

MGMichel GalinierHeart Failure & Transplant RIRomain ItierHeart Failure & Transplant AMAnthony MattaInterventional Cardiology

Key Result

Interventional specialized telemonitoring significantly reduced the odds of unplanned hospitalization (OR 0.303) and all-cause mortality (OR 0.255) compared to standard care in patients with chronic heart failure.

Study Design

Type

Cohort (n=414)

Blinding

Open-label

Multicenter

Structured PICO

Does interventional specialized telemonitoring reduce unplanned hospitalization and mortality in patients with chronic heart failure?

Population

414 patients with symptomatic chronic heart failure (NYHA stage ≥II) and recent acute decompensation, followed for a mean of 341 days.

Intervention

Interventional specialized telemonitoring (ITM) including daily weight and symptom monitoring, with immediate intervention by a cardiologist for alerts (diuretic adjustment, escalation therapy, or programmed hospitalization)

Comparator

Standard telemonitoring (STM) managed by a telemedical center and primary care physicians, and standard of care (SC)

Outcome

Unplanned hospitalization, all-cause death, and cardiovascular mortalityhard clinical

Interventional telemonitoring managed directly by a specialized cardiology team significantly reduces unplanned hospitalizations and mortality in heart failure patients compared to standard telemonitoring or standard care.

Main Result

Odds Ratio: 0.303 (95% CI 0.165–0.555)

Absolute Event Rate: 13.6% vs 36.8%

p-value: p=<0.001

Limitations

Retrospective study design pooling two different cohorts enrolled over different time spans
Differences in pharmacological treatment between groups (more ARNIs, ACEi, ARB, ivabradine in ITM group)
Absence of a control group in the most recent cohort
Low prevalence of cardiovascular events limiting power to detect statistical difference in cardiovascular mortality
Shorter duration of follow-up in the ITM group
Impact of COVID-19 pandemic on the number of received alerts

Abstract

Aims To assess the effect of interventional specialized telemonitoring (ITM) compared to standard telemonitoring (STM) and standard of care (SC) on preventing all causes of death, cardiovascular mortality and unplanned hospitalization in heart failure (HF) patients. Methods We compared outcomes in three groups of HF patients followed by different modalities: SC, STM and ITM. The telemonitoring was performed by the specialized HF-cardiology staff at Toulouse University Hospital. All patients were followed with the same manner including daily weight monitoring using on-line scales, self-monitoring and reporting symptoms via a device. The difference between groups was in the management of the received alerts. In STM-group, patients were contacted by a member of telemedical center and the main responsibility for patient's therapy was taken by their primary care physicians while in the ITM-group, a cardiologist intervenes immediately in case of alerts for diuretic dose adjustment or escalation therapy or programmed hospitalization if necessary. Outcomes were compared between the three study groups and Kaplan-Meier analysis was performed. Results Four hundred fourteen HF-patients derived from two French cohorts (OSICAT and ETAPES) were included in this study and subsequently enrolled in the following three groups: ITM-group ( n = 220), STM-group ( n = 99), and SC-group ( n = 95). During the mean follow-up period of 341 days, there were significantly fewer primary endpoints like unplanned hospitalization (13.6 vs. 34.3 vs. 36.8%, p 0.05), all-causes of death (4.5 vs. 20.2 vs. 16.8%, p 0.05) and cardiovascular mortality (3.2 vs. 15.2 vs. 8.4%, p 0.05) in the ITM-group. The multivariable logistic regression revealed a significant negative association between the ITM and unplanned hospitalization OR = 0.303 95% CI (0.165–0.555), p 0.001) and all-causes of death [OR = 0.255 95% CI (0.103–0.628), p = 0.003, respectively. Kaplan Meier and log rank test showed significant difference in median event-free survival in favor of ITM-group. Conclusions In the ITM follow-up HF group, delivered by a cardiology team, the rate of unplanned hospitalization and all-causes of death are lower than SC or STM.

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