Effects of tailored telemonitoring on functional status and health-related quality of life in patients with heart failure

Abstract

BackgroundFunctional status and health-related quality of life (HRQoL) are important in patients with heart failure (HF). Little is known about the effect of telemonitoring on functional status and HRQoL in that population.Methods and resultsA total of 382 patients with HF (New York Heart Association class 2–4) were included in a randomised controlled trial to investigate the effect of tailored telemonitoring on improving HRQoL and functional status in HF patients. Randomisation was computer-generated with stratification per centre. At baseline and after 12 months, patients’ functional status was determined by metabolic equivalent scores (METS). HRQoL was measured with the EuroQol five dimensions questionnaire (EQ-5D), visual analogue scale (VAS) and Borg rating of perceived exertion scale (Borg). Additional outcome data included number of HF-related outpatient clinic visits and mortality. Telemonitoring was statistically significantly related to an increase in METS after 1 year (regression coefficient 0.318; p = 0.01). Telemonitoring did not improve Borg, EQ-5D or VAS scores after 1 year. EQ-5D [hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.07–0.54], VAS (HR 0.98, 95% CI 0.96–0.99), Borg (HR 1.21, 95% CI 1.11–1.31) and METS (HR 0.73, 95% CI 0.58–0.93) at baseline were significantly associated with survival after 12 months.ConclusionsTailored telemonitoring stabilised the functional status of HF patients but did not improve HRQoL. Therefore, telemonitoring may help to prevent deterioration of exercise capacity in patients with HF. However, because our study is a reanalysis of a randomised controlled trial (RCT), this is considered hypothesis-generating and should be confirmed by adequately powered RCTs.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01323-x) contains supplementary material, which is available to authorized users.

Remote Monitoring in Chronic Heart Failure Patients: Is Non-Invasive Remote Monitoring the Way to Go?

“…We identified 31 studies that compared structured telephone support with usual care, which included a total of 11,270 patients [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. The study characteristics, as well as the reported outcomes on all-cause mortality, all-cause hospitalization, and HF-related hospitalization rates of the five largest studies, representing 49% (5560) of all patients, will be discussed in detail below [ 19 , 21 , 22 , 23 , 34 ].…”

“…The quality of life of patients who received structured telephone support improved significantly more than standard care in seven studies [ 19 , 21 , 22 , 26 , 28 , 41 , 45 ], and non-significantly in one study [ 27 ]. In contrast, five studies did not show a larger improvement in the quality of life [ 15 , 16 , 29 , 30 , 46 ].…”

“…Of the two studies reporting functional performance data in patients receiving structured telephone support, one study demonstrated a bigger improvement in the intervention group [ 16 ], while the other study did not observe a difference [ 34 ].…”

(Interventions in Care of Patients with Heart Failure for Improvement of Quality of Life)

“…Telemonitorování tedy dle této studie může pomoci zabránit zhoršení pohybové kapacity u této skupiny pacientů. 14 Podle odborného stanoviska expertů Asociace srdečního selhání Evropské kardiologické společnosti a jejich shrnutí nových poznatků v léčbě i péči o pacienty se srdečním selháním z roku 2019 může být telemedicína u těchto pacientů zvážena především s cílem snížit riziko rehospitalizací a úmrtí z kardiovaskulárních příčin. Dle dostupných vědeckých poznatků studie TIM-HF2 bylo prokázáno snížení rizika neplánované rehospitalizace a úmrtí díky dálkové monitoraci, která zahrnovala domácí měření hmotnosti, EKG, krevního tlaku a hodnocení zdravotního stavu ve strukturovaném systému s nepřetržitou podporou a dostupností lékaře a s úpravou léčby podle získaných údajů.…”

Health-related quality of life in elderly, multimorbid individuals with and without depression and/or mild cognitive impairment using a telemonitoring application

“…However, existing results are mixed regarding effects of home telemonitoring applications on HRQoL in elderly people with chronic diseases. Results from randomized controlled trials (RCTs) with elderly multimorbid people using a telemonitoring system showed improvements in HRQoL in study participants [19][20][21][22], although other telemonitoring RCTs could not achieve congruent results [23][24][25][26]. There is also evidence that the effects of telemonitoring on those with mental disorders, such as depression and mild cognitive impairment (MCI), can be promising [27][28][29].…”