Effect of Home-Based Telemonitoring Using Mobile Phone Technology on the Outcome of Heart Failure Patients After an Episode of Acute Decompensation: Randomized Controlled Trial

Abstract

BackgroundTelemonitoring of patients with chronic heart failure (CHF) is an emerging concept to detect early warning signs of impending acute decompensation in order to prevent hospitalization.ObjectiveThe goal of the MOBIle TELemonitoring in Heart Failure Patients Study (MOBITEL) was to evaluate the impact of home-based telemonitoring using Internet and mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation.MethodsPatients were randomly allocated to pharmacological treatment (control group) or to pharmacological treatment with telemedical surveillance for 6 months (tele group). Patients randomized into the tele group were equipped with mobile phone–based patient terminals for data acquisition and data transmission to the monitoring center. Study physicians had continuous access to the data via a secure Web portal. If transmitted values went outside individually adjustable borders, study physicians were sent an email alert. Primary endpoint was hospitalization for worsening CHF or death from cardiovascular cause.ResultsThe study was stopped after randomization of 120 patients (85 male, 35 female); median age was 66 years (IQR 62-72). The control group comprised 54 patients (39 male, 15 female) with a median age of 67 years (IQR 61-72), and the tele group included 54 patients (40 male, 14 female) with a median age of 65 years (IQR 62-72). There was no significant difference between groups with regard to baseline characteristics. Twelve tele group patients were unable to begin data transmission due to the inability of these patients to properly operate the mobile phone (“never beginners”). Four patients did not finish the study due to personal reasons. Intention-to-treat analysis at study end indicated that 18 control group patients (33%) reached the primary endpoint (1 death, 17 hospitalizations), compared with 11 tele group patients (17%, 0 deaths, 11 hospitalizations; relative risk reduction 50%, 95% CI 3-74%, P = .06). Per-protocol analysis revealed that 15% of tele group patients (0 deaths, 8 hospitalizations) reached the primary endpoint (relative risk reduction 54%, 95% CI 7-79%, P= .04). NYHA class improved by one class in tele group patients only (P< .001). Tele group patients who were hospitalized for worsening heart failure during the study had a significantly shorter length of stay (median 6.5 days, IQR 5.5-8.3) compared with control group patients (median 10.0 days, IQR 7.0-13.0; P= .04). The event rate of never beginners was not higher than the event rate of control group patients.ConclusionsTelemonitoring using mobile phones as patient terminals has the potential to reduce frequency and duration of heart failure hospitalizations. Providing elderly patients with an adequate user interface for daily data acquisition remains a challenging component of such a concept.

Usability of a CKD Educational Website Targeted to Patients and Their Family Members

“…Health IT use in the delivery of healthcare is growing rapidly, both in the adoption of electronic health records in healthcare systems and in the use of the internet and mobile phones for delivery of information between providers and patients (6,(15)(16)(17)(18)(19)(20)(21)(22). Applications vary in their design based on the expected interactive relationships ranging from provider to core knowledge reference source, provider with medical record, provider to provider, and provider with patient.…”

The Evolution of mHealth Interventions in Heart Failure

“…The MOBITEL study [32], a prospective, randomized study with 120 patients from eight clinical centers, approached HF management through: (i) detecting early warning signs of decompensation, (ii) reducing the high risk of re-hospitalization and, (iii) through providing valuable patient information to the treating physician. The enrolled patients were equipped with: (i) a mobile phone, (ii) a weight scale and, (iii) a sphygmomanometer for BP and HR measurements.…”

Information Technology Aspects of Integrated Cardiac Rhythm Disease Management

“…Remote monitoring is already used in several scientific studies (e.g. Scherr et al 2009) as well as in routine care (e.g. Kastner et al 2010), and its importance is likely to increase within the next years.…”

“…PICARD was designed so as to be able to receive data from remote monitoring systems and was already used in several studies concerning heart failure (Scherr et al, 2009), psoriasis (Hayn et al, 2009), diabetes (Kollmann et al, 2007c), and adipositas (Morak et al, 2008). Currently it is also used in a routine remote monitoring scenario (Kastner et al, 2010).…”