If home telemonitoring reduces mortality in heart failure, is this just due to better guideline-based treatment?

Dierckx, Riet; Cleland, John G.F.; Pellicori, Pierpaolo; Zhang, Jufen; Goode, Kevin; Putzu, Paola; Boyalla, Vennela; Clark, Andrew L.

doi:10.1177/1357633x15574947

Cited by 10 publications

(18 citation statements)

References 35 publications

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“…Modules rated useful and user-friendly. Empathy, perspective and coping with stress improved in the intervention group (though UK/Dutch results pooled). Score = 16 Hudson (2017) [46]Randomised controlled trialFeasibility of online cognitive behavioural therapy (CBT) intervention25 patients- 18 intervention, 7 controlOnline cognitive behavioural therapy using an iPad accompanied by telephone support.Patient’s home410 patients approached and 25 agreed to participate with 23 completing follow up. Adherence with online CBT higher in control arm.…”

Section: Resultsmentioning

confidence: 99%

“…Three of the papers were protocols [29, 33, 45] and three of the papers simply gave a description of the intervention without any identifiable study design [39, 53, 54] which served to address objective 1 of the study (description of current telehealth use). Other study designs included randomised crossover trial [31] mixed methods [37, 43] realist evaluation [55], prospective interventional [44], prospective longitudinal cohort [56], prospective observational [40, 57] and retrospective observational [46, 58].…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen of the included studies had a mix of participants (patients, carers and professionals) [30, 32, 36, 37, 40–43, 47, 50–52, 55, 57], nine were patient centred [29, 31, 33, 34, 44–46, 49, 58]and five were studies with telehealth interventions aimed at professionals [35, 38, 39, 54, 56]. Only one study by Hattink et al [48] described a telehealth intervention specifically for carers; an online education tool for carer-givers of those with advanced dementia.…”

Section: Resultsmentioning

confidence: 99%

“…There was a variety of telehealth interventions described in the included studies. The majority of interventions described a form of home telemonitoring (using telephone or computer software to record clinical symptoms or signs from the patient’s home) [29, 31, 37, 40, 41, 44–46, 49]. Home telemonitoring was used in a variety of conditions; respiratory disease, heart failure, motor neurone disease, cystic fibrosis and end stage renal failure.…”

Section: Resultsmentioning

confidence: 99%

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Telehealth in palliative care is being described but not evaluated: a systematic review

et al. 2019

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BackgroundTelehealth is growing and its application in palliative care is seen as a solution to pressures on palliative care services. A 2010 UK review reported growing awareness of telehealth in palliative care but a lack of evidence-based research to support its use. The primary aim of this review was to describe the current use of telehealth in palliative care in the UK and evaluate telehealth initiatives against a digital service standard. The secondary aim was to explore whether telehealth results in a reduction in emergency care access.MethodsSystematic review of the literature with thematic synthesis. Records were screened and data extracted by two reviewers. EMBASE, MEDLINE, CINAHL, Psychinfo and Cochrane central register for controlled trials were searched using pre-defined terms. Hand searching of conference literature, thesis databases and citation tracking was also conducted. The protocol for this systematic review was registered with PROSPERO and can be found at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080038.ResultsThe search identified 3807 titles and 30 studies were included in the review. Telehealth was used to support patients and carers, electronic record keeping and professional education. Notably, the number of home telemonitoring initiatives for patients had increased from the 2010 review. Despite this variety, many studies were small scale, descriptive and provided little evidence of evaluation of the service. Ten papers were sufficiently detailed to allow appraisal against the digital service standard and only one of these met all of the criteria to some extent. Seven studies made reference to emergency care access.ConclusionsAlthough there is growth of telehealth services, there remains a lack of evaluation and robust study design meaning conclusions regarding the clinical application of telehealth in palliative care cannot be drawn. There is insufficient evidence to appreciate any benefit of telehealth on access to emergency care. Future work is needed to evaluate the use of telehealth in palliative care and improve telehealth design in line with digital service standards.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Telehealth in palliative care is being described but not evaluated: a systematic review

et al. 2019

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“…Morbidity and mortality were high in the patient population under study, although lower than the patients who were invited but declined telemonitoring [18] or with patients matched for propensity scores [19]. For the study population, the Kaplan-Meier estimates at two years were 25% for all-cause-mortality and 50% for hospitalization due to worsening HF.…”

Section: A Patient Populationmentioning

confidence: 90%

Changes in Daily Measures of Blood Pressure and Heart Rate Improve Weight-Based Detection of Heart Failure Deterioration in Patients on Telemonitoring

Joshi

Gyllensten

2019

IEEE J. Biomed. Health Inform.

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Blood pressure (BP) and heart rate (HR) are often captured in conjunction with weight in telemonitoring systems, but the additional prognostic potential of daily measurements of BP and HR in providing information on upcoming hospitalizations for worsening heart failure (HFH) have not been explored thoroughly. We retrospectively analyzed 267 daily home-telemonitored heart failure (HF) subjects. We extracted those episodes of HFHs that had sufficient data entries in the days leading up to hospitalization and tested the prognostic potential of 48 trend features based on weight, systolic BP, diastolic BP, pulse pressure (PP) and HR with a Naïve Bayesian model. The single best-performing trend feature-with a cross-validated estimate of 0.64 for the area under the curve (AUC) with a standard deviation (SD) of 0.01-is based on a 2-day weight trend. The best multivariate feature set (cross-validated AUC=0.70, SD=0.01) comprises of 2-day trend features based on weight, systolic BP, and HR. There were large variations in the weight trends preceding hospitalizations and weight-change alone had a modest predictive ability. Readily interpretable features capturing trends in BP and HR provided additional prognostic information and can be used for improving classification.

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Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

Man,

Klopotowska,

Asselbergs

et al. 2024

Curr Heart Fail Rep

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Purposeof Review Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. Recent Findings We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. Summary There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional’s workload.

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If home telemonitoring reduces mortality in heart failure, is this just due to better guideline-based treatment?

Abstract: Patients who choose HTM have a better prognosis than those who do not but this does not appear to be mediated through greater prescription of key HF medications.

Cited by 10 publications

References 35 publications

Telehealth in palliative care is being described but not evaluated: a systematic review

Telehealth in palliative care is being described but not evaluated: a systematic review

Changes in Daily Measures of Blood Pressure and Heart Rate Improve Weight-Based Detection of Heart Failure Deterioration in Patients on Telemonitoring

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

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