Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study

Abstract

BackgroundDespite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF.ObjectiveThe objective of this study was to evaluate whether a new information communication technology (ICT)–based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients.MethodsIn this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management.ResultsAmong the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence.ConclusionsShort-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program.

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

“…Telemonitoring for heart failure patients is not new, and several studies have established the feasibility of these approaches and its positive impact on clinical outcome [34-36]. However, HerzMobil Tirol is a telemonitoring project that was able to transform from a pilot study to a routine care project.…”

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

“…Telemonitoring for heart failure patients is not new and several studies have established the feasibility of these approaches and its positive impact on clinical outcome (33)(34)(35).…”

Insufici�ncia card�aca e cren�as dificultadoras na ades�o ao tratamento

“…Nos Estados Unidos da América (EUA), cerca de 5,7 milhões de adultos têm IC e metade da população a desenvolve no período de 5 anos (1) . Nos EUA e na Europa, 30-50% dos pacientes diagnosticados com IC necessitam de re-hospitalização a cada 60 a 90 dias (1)(2) . Os pacientes com IC que necessitam de hospitalizarem para compensação constituem um grupo de maior gravidade, pois, enquanto os avanços tecnológicos no tratamento têm mostrado uma melhora do prognóstico, o crescimento nas hospitalizações é, ainda, um forte preditor ao aumento da mortalidade para este grupo (3)(4) , portanto um desafio no tratamento desta afecção.…”

“…Uma vez instalada, a IC causa um grande impacto na vida do paciente, o que pode ser explicado pelas limitações decorrentes dos sintomas físicos e psicológicos associados à síndrome (2)(3)(4) . Entre os sintomas físicos, destacamse a fadiga e a dispneia que se caracterizam pelo agravamento progressivo (5) .…”

“…Entende-se a adesão como o grau de conformidade entre as recomendações dos profissionais de saúde e o comportamento da pessoa relativamente ao regime terapêutico proposto, isto é, se toma a medicação, segue dietas ou muda hábitos de vida que coincidam com o regime terapêutico prescrito (6) . Em outros estudos, indica-se que o histórico socioeconômico, aspectos psicológicos e grau de escolaridade são fatores que influenciam os padrões de adesão pela população com IC (2)(3)(6)(7) . No Brasil, a principal etiologia da IC é a cardiopatia isquêmica crônica associada à hipertensão arterial (8) .…”