Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM‐HF2 trial

Abstract

Aims The TIM‐HF2 study showed less days lost due to unplanned cardiovascular hospitalization or all‐cause death and improved survival in patients randomly assigned to remote patient management (RPM) instead of standard of care. Methods and results This substudy explored whether the biomarkers mid‐regional pro‐adrenomedullin (MR‐proADM) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) could be used to identify low‐risk patients unlikely to benefit from RPM, thereby allowing more efficient allocation of the intervention. For 1538 patients of the trial (median age 73 years, interquartile range 64–78 years, 30% female), baseline biomarkers were used to select subpopulations recommended for RPM with various safety endpoints (100%, 98%, 95% sensitivity), and efficacy of RPM was assessed. Both biomarkers were strongly associated with events. The primary endpoint of lost days increased from 1.0% (1.4%) in the lowest to 17.3% (17.6%) in the highest quintile of NT‐proBNP (MR‐proADM). After combining biomarkers to identify patients recommended for RPM with 95% sensitivity, in the most efficient scenario (excluding 27% of patients; NT‐proBNP < 413.7 pg/mL and MR‐proADM < 0.75 nmol/L), the effect of RPM on patients was highly similar to the original trial (ratio of lost days: 0.78, hazard ratio for all‐cause death: 0.68). Number needed to treat for all‐cause death was lowered from 28 to 21. Rates of emergencies and telemedical efforts were significantly lower among patients not recommended for RPM. Biomarker guidance would have saved about 150 h effort/year per 100 patients of the eligible population. Conclusions The combined use of MR‐proADM and NT‐proBNP may allow safe, more precise, effective and cost‐saving allocation of patients with heart failure to RPM and warrants further prospective studies.

Short-Term Therapies for Treatment of Acute and Advanced Heart Failure—Why so Few Drugs Available in Clinical Use, Why Even Fewer in the Pipeline?

“…Similar technologies might also be deployed to optimise the functioning and performance of specialist AdHF units such as that recently described by Kreusser and colleagues [73]. The success of the TIM-HF2 (NCT01878630) trial of telemedical interventional management in reducing unplanned cardiovascular hospital admissions and all-cause mortality is also highly pertinent in this context [74,75].…”

Benefits of Home-Based Solutions for Diagnosis and Treatment of Acute Coronary Syndromes on Health Care Costs: A Systematic Review

“…In this study of 315 HF patients, improved outcome metrics included a 50% decrease in HF-hospitalizations and a 24% reduction in all-cause hospitalization, a 59% reduction in cardiac biomarker levels and a meaningful improvement of the patients' QoL, assessed by questionnaires. These findings were corroborated by the Telemedicine Interventional Management in Heart Failure II (TIM-HF2) trial [64] in which 1538 HF patients were retrospectively studied over a 12-month follow up period. Interestingly, this study also tried to evaluate the amount of time saved after the implementation of these programs.…”

“…Regarding secondary prevention or disease treatment, risk monitoring with home-based solutions was also shown to be very effective in improving quality of life (QoL), in reducing recurrent events, rehospitalization and all-cause mortality of cardiac patients [60][61][62][63][64]. Out of all CVD patients, those suffering from HF are the ones with the highest associated healthcare expenditure.…”

Heart failure patients with atrial fibrillation benefit from remote patient management: insights from the TIM‐HF2 trial

“…Potential selection criteria can include cardiac biomarkers such as NT-proBNP and MR-proADM. 32 This TIM-HF2 analysis identifies the potential of the baseline ECG as an additional and widely available selection criterion.…”