Chronic heart failure needs constant care and regular monitoring. Now research says remote monitoring, either over the phone or using wireless technology, helps people with heart failure live longer and stay out of hospital.
Heart failure affects about 900,000 people in the UK with a similar number having damage to their heart that is not severe enough to cause symptoms. Heart failure reduces the heart's ability to pump blood. Coronary artery disease is the most common cause of heart failure. It can be treated with drugs, and with lifestyle changes such as taking more exercise. Nearly 4 in 10 people die within a year of being diagnosed.
Now a phone-based or online support and monitoring for heart failure patients has been tried to keep a regular watch on the deterioration or improvement of symptoms of heart failure. The common monitored parameters include weight, blood pressure, pulse, and blood oxygen levels. Equipment connected to the phone can detect these parameters. The results are transmitted to the hospital or clinic, where they are reviewed by a doctor or specialist nurse.
For the study researchers combined data from 25 studies on remote monitoring including 2,710 people. Of the 25 full peer-reviewed studies, 16 evaluated structured telephone support, including 5,613 participants; 11 evaluated telemonitoring, including 2,710 participants; and two tested both interventions. Among people taking part in a programme to monitor their heart failure, 102 in 1,000 died during the study period (typically about 12 months). This compared with 154 in 1,000 people who didn't get remote monitoring. The trials looking at telephone support without online monitoring included 5,613 people. About 112 in 1,000 people getting phone support died during the trials, compared with 127 in 1,000 people in the comparison group. Telemonitoring reduced the risk of all-cause mortality by 34%
Both remote monitoring and telephone support meant people were less likely to need admitting to hospital with worsening heart failure.
The study was published in the Cochrane Database Systematic Reviews on August 4, 2010.
Dr Sally Inglis (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) and colleagues wrote, “Structured telephone support and telemonitoring reduced healthcare costs, were acceptable to patients, improved prescribing of evidence-based pharmacotherapies, improved patient heart-failure knowledge and self-care behaviors, and even improved NYHA functional class in those studies that assessed it.”
Dr. Inglis said, teaching patients to “evaluate and monitor their condition and then send or relay this information to the specialist nurse or doctor allows for early intervention, and our review findings suggest that doing so may lead to a lowered risk of mortality, perhaps by preventing serious complications or deterioration of the patient's condition…In general, telemonitoring or structured telephone support appeared to be useful for all patients with chronic heart failure…Only 3% to 4% of participants in these studies were unable to learn to use the technology.”
She also added that there are still important aspects of these interventions that require further evaluation. “Very few studies have reported details of cost; cost-effectiveness and cost savings are yet to be determined for these interventions. More work is required on the business models underlying the cost-effectiveness of telemonitoring in particular, and the optimum duration of follow-up when providing these interventions remains to be identified.”
In a related editorial published online August 9, 2010, Dr Juan-Pablo Casas (London School of Hygiene & Tropical Medicine, UK) and colleagues pointed out that “taken at face value, these results make a strong case for embedding telephone support and telemonitoring into routine patient care. . . . However, telemonitoring may give false reassurance that may in turn result in adverse events, which were not considered [in this analysis].”
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