HerzMobil, an Integrated and Collaborative Telemonitoring-Based Disease Management Program for Patients With Heart Failure: A Feasibility Study Paving the Way to Routine Care

Abstract

BackgroundHeart failure is a major health problem associated with frequent hospital admissions. HerzMobil Tirol is a multidisciplinary postdischarge disease management program for heart failure patients to improve quality of life, prevent readmission, and reduce mortality and health care costs. It uses a telemonitoring system that is incorporated into a network of specialized heart failure nurses, physicians, and hospitals. Patients are equipped with a mobile phone, a weighing scale, and a blood pressure and heart rate monitor for daily acquisition and transmission of data on blood pressure, heart rate, weight, well-being, and drug intake. These data are transmitted daily and regularly reviewed by the network team. In addition, patients are scheduled for 3 visits with the network physician and 2 visits with the heart failure nurse within 3 months after hospitalization for acute heart failure.ObjectiveThe objectives of this study were to evaluate the feasibility of HerzMobil Tirol by analyzing changes in health status as well as patients’ self-care behavior and satisfaction and to derive recommendations for implementing a telemonitoring-based interdisciplinary disease management program for heart failure in everyday clinical practice.MethodsIn this prospective, pilot, single-arm study including 35 elderly patients, the feasibility of HerzMobil Tirol was assessed by analyzing changes in health status (via Kansas City Cardiomyopathy Questionnaire, KCCQ), patients’ self-care behavior (via European Heart Failure Self-Care Behavior Scale, revised into a 9-item scale, EHFScB-9), and user satisfaction (via Delone and McLean System Success Model).ResultsA total of 43 patients joined the HerzMobil Tirol program, and of these, 35 patients completed it. The mean age of participants was 67 years (range: 43-86 years). Health status (KCCQ, range: 0-100) improved from 46.2 to 69.8 after 3 months. Self-care behavior (EHFScB-9, possible range: 9-22) after 3 months was 13.2. Patient satisfaction in all dimensions was 86% or higher. Lessons learned for the rollout of HerzMobil Tirol comprise a definite time schedule for interventions, solid network structures with clear process definition, a network coordinator, and specially trained heart failure nurses.ConclusionsOn the basis of the positive evaluation results, HerzMobil Tirol has been officially introduced in the province of Tyrol in July 2017. It is, therefore, the first regular financed telehealth care program in Austria.

Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM‐HF) study

“…Depressive symptoms were prospectively evaluated by the 9-item Patient Health Questionnaire (PHQ-9) in self-administration at baseline and on every follow-up visit (months 3,6,9,12,18,24). The PHQ-9 represents the 9-item depression module of the PHQ, a questionnaire used to screen for the five most common mental health disorders in primary care.…”

“…Remote patient management using telemedicine has emerged as a tool to optimize therapy, improve compliance, and enable detection of signs and symptoms of cardiac decompensation in CHF 12,13 . However, there are very limited data available on the effects of a telemedicine programme on depressive symptoms and quality of life.…”

“…[8][9][10][11] Remote patient management using telemedicine has emerged as a tool to optimize therapy, improve compliance, and enable detection of signs and symptoms of cardiac decompensation in CHF. 12,13 However, there are very limited data available on the effects of a telemedicine programme on depressive symptoms and quality of life. The complex intervention interferes with patients' daily life and thus could potentially exert positive effects but also may induce or increase both depressiveness and quality of life.…”

Heart failure disease management programs in Austria 2019

“…Kardiomobil Salzburg is required to submit an annual performance report to the funding institution. Two programs are subjected to an annual external quality control by the provider (Krems Model) and the Private University for Health Science, Medical Informatics and Technology, Tyrol (HerzMobil Tirol) [19].…”

“…Currently, seven individual DMPs are operating in six regions in Austria ranging from Carinthia (Klagenfurt) to Lower Austria (Krems), Salzburg, Styria, Tyrol, and Upper Austria (Braunau, Linz) (in alphabetical order). Kardiomobil Kärnten (January 2019-December 2020), Integrierte Versorgung von Patienten mit Herzinsuffizienz in Oberösterreich -IVH OÖ-Pilot (January 2017 to December 2019), and KardioStabil Braunau (June 2017 to unlimited) are still in a project phase, while Kardiomobil Salzburg (since 2008) [11], the Krems model (since 2008) [12] and HerzMobil Tirol (2012-2017 in a project phase, established since July 2017) [13][14][15][16][17][18][19] and HerzMobil Stmk (since January 2019) are already established programs.…”