Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote Patient Management (RPM) enables early detection and prevention of cardiac deterioration in heart failure (HF) patients by measuring vital signs. Clinical trials reported inconsistent results. Patient adherence was suggested to be one of the main reasons for inconsistent results in previous trials (2-4). The "Telemedical interventional management in heart failure II (TIM-HF2)" study showed the superiority of non-invasive RPM compared to usual care (UC) in terms of mortality and unplanned cardiovascular (CV) hospitalisation (1). Purpose The objective of the analysis is to assess the patient experience with RPM, the adherence to daily measurements and outline factors affecting both aspects. Methods TIM-HF2 was conducted 2013-2018 with 1,538 HF patients in a 12-month follow-up (5). Inclusion criteria were HF in NYHA class II or III with either LVEF ≤45% or, if LVEF >45%, patients had been treated with oral diuretics; and HF hospitalisation within the last 12 months. Patients with major depression were excluded. Patients were randomly assigned (1:1) to RPM or UC. RPM-Patients had to measure daily weight, blood pressure, ECG and self-rated health status. Data were sent automatically to the telemedical centre (TMC). In case of conspicuous findings, the TMC contacted the patient or GP for therapy adjustment. At the study end, RPM-patients were asked to evaluate the program through a 9-question survey. Adherence was distinguished between measurement of at least one (incomplete adherence- IA) and all vital parameters (complete adherence- CA) and defined as ratio of the number of days of measurements taken divided by the number of days of possible measurements. All data were analysed descriptively (mean ± standard deviation). Differences between groups were analysed by ANOVA and T-Test. Results The survey was answered by n=564 patients (response rate: 79.7%). The patients were satisfied with the program and device usability. CA was 89.1±14.1% and consistently high over the study course (table 1). Reasons for dropouts (n=37) were e.g. frustration with the devices and physical inability to complete the measurement protocol. Patients <70 years and living in rural areas had lower IA rates. The mean adherence was independent of severe of disease (LVEF, NTproBNP, NYHA). Patients (n=244) had significantly lower IA the week prior to an unplanned CV hospitalisation (difference by -5.2±20.5%) compared to the entire study period. IA was significantly lower by -12.8±24.7% in the week after an unplanned CV hospitalisation compared to the entire study period. Conclusions In a setting with user-friendly devices, pre-interventional patient training, regular TMC-patient contact and close cooperation between primary physicians and TMC a long-lasting and high adherence and satisfaction regarding RPM could be achieved. A change in adherence might detect deterioration in health status and indicate the need to intensify telemedical care.
Aims We investigated the implementation of new guidelines in ST-segment elevation myocardial infarction (STEMI) patients in a large real-world patient population in the metropolitan area of Berlin (Germany) over a 20-year period. Methods From January 2000 to December 2019, a total of 25 792 patients were admitted with STEMI to one of the 34 member hospitals of the Berlin-Brandenburg Myocardial Infarction Registry (B2HIR) and were stratified for sex and age < 75 and ≥ 75 years. Results The median age of women was 72 years (IQR 61–81) compared to 61 years in men (IQR 51–71). PCI treatment as a standard of care was implemented in men earlier than in women across all age groups. It took two years from the 2017 class IA ESC STEMI guideline recommendation to prefer the radial access route rather than femoral until > 60% of patients were treated accordingly. In 2019, less than 60% of elderly women were treated via a radial access. While the majority of patients < 75 years already received ticagrelor or prasugrel as antiplatelet agent in the year of the class IA ESC STEMI guideline recommendation in 2012, men ≥ 75 years lagged two years and women ≥ 75 three years behind. Amongst the elderly, in-hospital mortality was 22.6% (737) for women and 17.3% (523) for men (p < 0.001). In patients < 75 years fatal outcome was less likely with 7.2% (305) in women and 5.8% (833) in men (p < 0.001). After adjustment for confounding variables, female sex was an independent predictor of in-hospital mortality in patients ≥ 75 years (OR 1.37, 95% CI 1.12–1.68, p = 0.002), but not in patients < 75 years (p = 0.076). Conclusion In-hospital mortality differs considerably by age and sex and remains highest in elderly patients and in particular in elderly females. In these patient groups, guideline recommended therapies were implemented with a significant delay. Graphical abstract
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