Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients
Abstract
1. Introduction
2. Materials and Methods
3. Statistical Analysis
4. Results
5. Discussion
6. Limitations of the Study
Author Contributions
Conflicts of Interest
References
- Scarborough, P.; Bhatnagar, P.; Wickramasinghe, K.; Smolina, K.; Mitchell, C.; Rayner, M. Coronary Heart Disease Statistics, 2010 ed.; British Heart Foundation: London, UK, 2010. [Google Scholar]
- Stewart, S.; Jenkin, A.; Buchan, S.; McGuire, A.; Capewell, S.; McMurray, J.J. The current cost of heart failure to the National Service in the UK. Eur. J. Heart Fail. 2002, 4, 361–371. [Google Scholar] [CrossRef]
- Riley, J.P.; Cowie, M.R. Telemonitoring in heart failure. Heart 2009, 95, 1964–1968. [Google Scholar] [CrossRef] [PubMed]
- Cleland, J.G.; Swedberg, K.; Follath, F.; Komajda, M.; Cohen-Solal, A.; Aguilar, J.C.; Dietz, R.; Gavazzi, A.; Hobbs, R.; Korewicki, J.; et al. The EuroHeart Failure survey programme—A survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis. Eur. Heart J. 2003, 24, 442–463. [Google Scholar] [CrossRef]
- Michalsen, A.; Konig, G.; Thimmew, W. Preventable causative factors leading to hospital admission with decompensation heart failure. Heart 1998, 80, 437–441. [Google Scholar] [CrossRef] [PubMed]
- Roccaforte, R.; Demers, C.; Baldassarre, F.; Teo, K.K.; Yusuf, S. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. Eur. J. Heart Fail. 2005, 7, 1133–1144. [Google Scholar] [CrossRef] [PubMed]
- Schwarz, K.A.; Mion, L.C.; Hudock, D.; Litman, G. Telemonitoring of heart failure patients and their caregivers: A pilot randomized controlled trial. Prog. Cardiovasc. Nurs. 2008, 23, 18–26. [Google Scholar] [CrossRef] [PubMed]
- Schmidt, S.; Schuchert, A.; Krieg, T.; Oeff, M. Home telemonitoring in patients with chronic heart failure: A chance to improve patient care? Dtsch. Arztebl. Int. 2010, 107, 131–138. [Google Scholar] [PubMed]
- Di Lenarda, A.; Scherillo, M.; Maggioni, A.P.; Acquarone, N.; Ambrosio, G.B.; Annicchiarico, M.; Bellis, P.; Bellotti, P.; De Maria, R.; Lavecchia, R.; et al. Current presentation and management of heart failure in cardiology and internal medicine hospital units: A tale of two worlds. The TEMISTOCLE study. Am. Heart J. 2003, 146, E12. [Google Scholar] [CrossRef]
- Hernandez, A.F.; Greiner, M.A.; Fonarow, G.C.; Hammill, B.G.; Heidenreich, P.A.; Yancy, C.W.; Peterson, E.D.; Curtis, L.H. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA 2010, 303, 1716–1722. [Google Scholar] [CrossRef] [PubMed]
- Di Tano, G.; De Maria, R.; Gonzini, L.; Aspromonte, N.; Di Lenarda, A.; Feola, M.; Marini, M.; Milli, M.; Misuraca, G.; Mortara, A.; et al. IN-HF Outcome Investigators. The 30-day metric in acute heart failure revisited: Data from IN-HF Outcome, an Italian nationwide cardiology registry. Eur. J. Heart Fail. 2015, 17, 1032–1041. [Google Scholar] [CrossRef] [PubMed]
- Sahn, D.J.; Demaria, A.; Kisslo, J.; Weyman, A. The committee on M mode standardisation of the American Society of Echocardiography: Recommendations regarding quantification in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 1978, 58, 1072–1083. [Google Scholar] [CrossRef] [PubMed]
- ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS Statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med. 2002, 166, 111–117. [Google Scholar]
- Mahoney, F.; Barthel, D. Functional evaluation: The Barthel Index. Md. State Med. J. 1965, 14, 61–65. [Google Scholar] [PubMed]
- Mortara, A.; Oliva, F.; Di Lenarda, A. Current perspectives in telemonitoring and devices in chronic heart failure patients: Lights and shadows. G. Ital. Cardiol. (Rome) 2010, 11, 33S–37S. [Google Scholar]
- Polisena, J.; Tran, K.; Cimon, K.; Hutton, B.; McGill, S.; Palmer, K.; Scott, R.E. Home telemonitoring for congestive heart failure: A systematic review and meta-analysis. J. Telemed. Telecare 2010, 16, 68–76. [Google Scholar] [CrossRef] [PubMed]
- Klersy, C.; De Silvestri, A.; Gabutti, G.; Regoli, F.; Auricchio, A. A meta-analysis of remote monitoring of heart failure patients. J. Am. Coll. Cardiol. 2009, 54, 1683–1694. [Google Scholar] [CrossRef] [PubMed]
- Clark, R.A.; Inglis, S.C.; McAlister, F.A.; Cleland, J.G.; Stewart, S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: Systematic review and meta-analysis. BMJ 2007, 334, 942. [Google Scholar] [CrossRef] [PubMed]
- Chaudhry, S.I.; Phillips, C.O.; Stewart, S.S.; Riegel, B.; Mattera, J.A.; Jerant, A.F.; Krumholz, H.M. Telemonitoring for patients with chronic heart failure: A systematic review. J. Card. Fail. 2007, 13, 56–62. [Google Scholar] [CrossRef] [PubMed]
- Seto, E. Cost comparison between telemonitoring and usual care of heart failure: A systematic review. Telemed. J. E-Health 2008, 14, 679–686. [Google Scholar] [CrossRef] [PubMed]
- Takeda, A.; Taylor, R.S.; Khan, F.; Krum, M.; Underwood, M. Clinical service organization for herat failure. Cochrane Database Syst. Rev. 2012. [Google Scholar] [CrossRef] [PubMed]
- Brunetti, N.D.; Scalvini, S.; Acquistapace, F.; Parati, G.; Volterrani, M.; Fedele, F.; Molinari, G. Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Infermatics. Int. J. Cardiol. 2015, 184, 452–458. [Google Scholar] [CrossRef] [PubMed]
- Feola, M. The prognostic value of different biomarkers in predicting clinical outcome in discharged heart failure patients. Minerva Cardioangiol. 2016, 64, 145–146. [Google Scholar] [PubMed]
- Knox, L.; Rahman, R.J.; Beedie, C. Quality of life in patients receiving telemedicine enhanced chronic heart failure disease management: A meta-analysis. J. Telemed. Telecare 2017, 23, 639–649. [Google Scholar] [CrossRef] [PubMed]
- Van Spall, H.G.C.; Rahman, T.; Mytton, O.; Ramasundarahettige, C.; Ibrahim, Q.; Kabali, C.; Coppens, M.; Haynes, R.B.; Connolly, S. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: A systematic review and network meta-analysis. Eur. J. Heart Fail. 2017, 11, 1427–1443. [Google Scholar] [CrossRef] [PubMed]
- Bashushur, R.L.; Shannon, G.W.; Smith, B.R. The empirical foundations of telemedicine intervention for chronic disease management. Telemed. J. E-Health 2014, 20, 769–800. [Google Scholar] [CrossRef] [PubMed]
- Ponikowski, P.; Voors, A.A.; Anker, S.D.; Bueno, H.; Cleland, J.G.; Coats, A.J.; Falk, V.; González-Juanatey, J.R.; Harjola, V.P.; Jankowska, E.A.; et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. J. Heart Fail. 2016, 18, 891–970. [Google Scholar] [CrossRef] [PubMed]
n = 48 | |
---|---|
Age | 80.4 ± 7.7 (range 53–93) |
Males | 28 (58.3%) |
Ischemic CMP | 15 |
Valvular CMP | 14 |
Other CMP | 19 |
SR/AF | 20/28 |
Creatinine (mg/dL) | 1.6 ± 0.6 |
Haemoglobin (g/dL) | 11.7± 1.0 |
Sodium (mEq/L) | 139.6 ± 2.9 |
LVEF [%] in patients with preserved EF (EF ≥ 55%) (n = 11) | 58.9± 4.9 |
LVEF [%] in patients with impaired EF (EF < 55%) (n = 37) | 33.2 ± 10.7 |
NYHA at enrolment | 3.2 ± 0.8 |
BNP at enrollment (pg/mL) | 1082.9 ± 1146.6 |
6MWT at enrollment (m) (n = 14) | 248.6 ± 88.4 |
Barthel Index at enrolment | 77.9 ± 23.7 |
Alarm parameters (%) (n = 44) | 43 |
24 h Ambulatory visit (%) (n = 44) | 18 |
ED visit (%) (n = 44) | 11 |
Hospital admission (%) (n = 44) | 18 |
Cardiovascular death (n = 44) | 13 (29.5%) |
Lost at FU | 4 (8.3%) |
Costs (€/Year) | ED Admissions (n°/Year) | 30-Day Readmission (n°) | |
---|---|---|---|
Before Telemedicine enrolment | 116.856 | 21 (47.7%) | 35 (21.3%) |
After Telemedicine enrollment | 40.065 | 5 (11.4%) | 12 (6.2%) |
Satisfaction Questionnaire | (n° of Patients) |
---|---|
How to assess the number of visits received at home? | 0–40% (4) |
40–80% (23) | |
80–100% (0) | |
What is the possibility of carrying out checks at home instead of in hospital? | 0–40% (0) |
40–80% (10) | |
80–100% (17) | |
Do you prefer to carry out checks at home instead of in hospital? | 0–40% (1) |
40–80% (11) | |
80–100% (15) | |
Is the presence of a nurse at home helpful? | 0–40% (0) |
40–80% (7) | |
80–100% (20) | |
Were caregivers satisfied with the visit at home instead of in hospital? | 0–40% (0) |
40–80% (20) | |
80–100% (7) | |
Have additional check-ups required by the doctor been helpful? | 0–40% (0) |
40–80% (21) | |
80–100% (6) | |
Would you recommend to a friend, if needed, this telemedicine service? | 0–40% (0) |
40–80% (7) | |
80–100% (20) |
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Share and Cite
Burdese, E.; Testa, M.; Raucci, P.; Ferreri, C.; Giovannini, G.; Lombardo, E.; Avogadri, E.; Feola, M. Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients. Diseases 2018, 6, 10. https://doi.org/10.3390/diseases6010010
Burdese E, Testa M, Raucci P, Ferreri C, Giovannini G, Lombardo E, Avogadri E, Feola M. Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients. Diseases. 2018; 6(1):10. https://doi.org/10.3390/diseases6010010
Chicago/Turabian StyleBurdese, Emanuela, Marzia Testa, Pasquale Raucci, Cinzia Ferreri, Gabriele Giovannini, Enrico Lombardo, Enrico Avogadri, and Mauro Feola. 2018. "Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients" Diseases 6, no. 1: 10. https://doi.org/10.3390/diseases6010010
APA StyleBurdese, E., Testa, M., Raucci, P., Ferreri, C., Giovannini, G., Lombardo, E., Avogadri, E., & Feola, M. (2018). Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients. Diseases, 6(1), 10. https://doi.org/10.3390/diseases6010010