Impact of telemedicine on the clinical outcomes and healthcare costs of patients with chronic heart failure and mid-range or preserved ejection fraction managed in a multidisciplinary chronic heart failure programme: A sub-analysis of the iCOR randomized trial

Abstract

Background The efficacy of telemedicine in the management of patients with chronic heart failure and left ventricular ejection fraction ≥40% is poorly understood. The aim of our analysis was to evaluate the efficacy of a telemedicine-based intervention specifically in these patients, as compared to standard of care alone. Methods The Insuficiència Cardiaca Optimització Remota (iCOR) study was a single centre, randomised, controlled trial, designed to evaluate a telemedicine intervention added to an existing hospital/primary care multidisciplinary, integrated programme for chronic heart failure patients. 178 participants were randomised to telemedicine or usual care, and were followed for six months. For the present sub-analysis, only iCOR participants (n = 116) with left ventricular ejection fraction ≥40% were included. The primary study endpoint was the incidence of an acute non-fatal heart failure event, defined as a new episode of worsening of symptoms and signs consistent with acute heart failure requiring intravenous diuretic therapy. The healthcare-related costs in each study group were also evaluated. Results The incidence of the first occurrence of the primary endpoint was significantly lower in the telemedicine arm (22% vs 56%, p<0.001), with a hazard ratio of 0.33 comparing to the usual care arm (95% confidence interval 0.17-0.64). Telemedicine was also associated with lower mean overall chronic heart failure care-related costs compared to usual care (8163€ vs 4993€, p=0.001). The results were consistent in both left ventricular ejection fraction of 40-49% and left ventricular ejection fraction ≥50% patients. Conclusions Our results suggest that telemedicine is a promising strategy for the management of chronic heart failure patients with left ventricular ejection fraction ≥40%. These findings should be replicated in larger cohorts.

Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial

“…Frederix et al 48 reported insignificant long-term savings of approximately 27% from an initial 6 month telehealthcare intervention. Jiménez-Marrero et al 49 report savings of approximately 38% for a subgroup of HF patients with a left ventricular ejection fraction >40. Comín-Colet et al 50 report savings of approximately 45%, mainly driven by a significant reduction in hospitalisations between the telehealthcare group and control group.…”

Study design of Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS)

“…In contrast with usual HF programme models, where only highly selected patients are candidates to be managed in hospital‐based units and delivery of care is based on face‐to‐face encounters, these new remote management transitional care models delivered using mHealth platforms allow extending a high standard of care to real‐world patients who are often expelled from specialized hospital care. Interestingly, in our previous study, we showed that the efficacy of TM combining telemonitoring and teleintervention was similar in all patients regardless of age, frailty, co‐morbidities, and ejection fraction 7,13 . This approach will reduce patient inequalities in access to good quality of care.…”

“…Particularly, combining, from one side, teleintervention by VC to deliver structured pre‐planned interventions and, from the other side, telemonitoring of signs and symptoms, may be an effective strategy especially for those patients with HF in the so‐called ‘vulnerable phase’ , the period that encompasses discharge from an acute HF admission and the following early post‐discharge period. Besides, from the subgroup analyses of the iCOR study, 7 we believe that the benefit will extend to all HF patients in the ‘vulnerable phase’ regardless of LVEF, 13 presence of frailty, depressive symptoms, or co‐morbidities. The purpose of the HERMeS trial will also include validation of the main results of the iCOR study in a nationwide ‘vulnerable phase’ HF patient's cohort and confirm the robustness of the results among different clinical subgroups of patients and diverse health care settings.…”

“…In this small study, we demonstrated that adding a combination of telemonitoring and teleintervention to an existing comprehensive HF programme reduced the risk of non‐fatal HF events and the risk of HF and cardiovascular (CV)‐related readmissions as compared with structured follow‐up based on face‐to‐face appointments. These benefits were seen across pre‐specified subgroups of patients and were accompanied by a reduction in hospital costs and improvement in patient‐centred outcomes 7,13 …”

The NCSBN 2019 Environmental Scan: 40th Anniversary Edition

“…A recent study on the effectiveness of nurse-led telemedicine teams in a regional healthcare system showed a significant decrease across several acute stroke metrics (Fowler et al, in press). Additional evidence shows rural health systems can reduce patient mortality while reducing costs (Siwicki, 2018), help patients and clinicians more effectively manage chronic diseases, such as diabetes and chronic heart failure (Kim, Park, Lee, Jung, & Park, 2018;Jiménez-Marrero et al, 2018), and use mental health technologies that have considerable promise (Wozney et al, 2018).…”