Telemonitoring versus standard care in heart failure: a randomised multicentre trial

Abstract

AimsThe aim was to assess the effect of a telemonitoring programme vs. standard care (SC) in preventing all‐cause deaths or unplanned hospitalisations in heart failure (HF) at 18 months.Methods and resultsOSICAT was a randomised, multicentre, open‐label French study in 937 patients hospitalised for acute HF ≤12 months before inclusion. Patients were randomised to telemonitoring (daily body weight measurement, daily recording of HF symptoms, and personalised education) (n = 482) or to SC (n = 455). Mean ± standard deviation number of events for the primary outcome was 1.30 ± 1.85 for telemonitoring and 1.46 ± 1.98 for SC [rate ratio 0.97, 95% confidence interval (CI) 0.77–1.23; P = 0.80]. In New York Heart Association (NYHA) class III or IV HF, median time to all‐cause death or first unplanned hospitalisation was 82 days in the telemonitoring group and 67 days in the SC group (P = 0.03). After adjustment for known predictive factors, telemonitoring was associated with a 21% relative risk reduction in first unplanned hospitalisation for HF [hazard ratio (HR) 0.79, 95% CI 0.62–0.99; P = 0.044); the relative risk reduction was 29% in patients with NYHA class III or IV HF (HR 0.71, 95% CI 0.53–0.95; P = 0.02), 38% in socially isolated patients (HR 0.62, 95% CI 0.39–0.98; P = 0.043), and 37% in patients who were ≥70% adherent to body weight measurement (HR 0.63, 95% CI 0.45–0.88; P = 0.006).ConclusionTelemonitoring did not result in a significantly lower rate of all‐cause deaths or unplanned hospitalisations in HF patients. The pre‐specified subgroup results suggest the telemonitoring approach improves clinical outcomes in selected populations but need further confirmation.

Beyond the stethoscope: managing ambulatory heart failure during the COVID‐19 pandemic

“…Each of these studies have demonstrated the feasibility of telemonitoring. While these strategies have not been shown to consistently effect clinical outcomes, they were conducted in a non‐pandemic environment in which access to in‐person ambulatory care was unrestricted 21–25 . Furthermore, a Cochrane meta‐analysis found that both telemonitoring and telephone support reduced mortality and heart failure‐related hospitalizations 26 …”

Cardiac Resynchronization Therapy Remote Monitoring – COVID-19 Pandemic Experiences and Future Perspectives

“…More clinical research in this field could clarify it 15 , 16 , 20 . However, remote monitoring generally became an advised approach in CRT treated patients’ follow-up.…”

Good Performance in the Management of Acute Heart Failure in Cardiogeriatric Departments : The ICREX-94 Experience

“…In 2018, in the 10 hospitals participating in this study, 2393 heart failure admissions were recorded by the "Caisse Primaire d'Assurance Maladie" (French health insurance fund), representing 85% of all AHF admissions in Val-de-Marne. In 2016, ten Val-de-Marne cardiology and cardiogeriatrics departments, academic and nonacademic, public and private, large and small, interested in HF care, decided to create a network (FINC94) and to collaborate, in order to share their experiences, train healthcare professionals and conduct clinical studies such as this one (20). There were seven classical cardiology departments, found in both teaching and nonteaching hospitals, public and private, and three cardiogeriatrics departments specialized in heart failure management, with geriatricians who had received speci c academic and practical training in cardiovascular medicine.…”