The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF)

Abstract

Home telemonitoring is becoming more important to home medical care for patients with heart failure. Since there are no data on home telemonitoring for Japanese patients with heart failure, we investigated its effect on cardiovascular outcomes. The HOMES-HF study was the first multicenter, open-label, randomized, controlled trial (RCT) to elucidate the effectiveness of home telemonitoring of physiological data, such as body weight, blood pressure, and pulse rate, for Japanese patients with heart failure (UMIN Clinical Trials Registry 000006839). The primary end-point was a composite of all-cause death or rehospitalization due to worsening heart failure. We analyzed 181 recently hospitalized patients with heart failure who were randomly assigned to a telemonitoring group (n = 90) or a usual care group (n = 91). The mean follow-up period was 15 (range 0-31) months. There was no statistically significant difference in the primary end-point between groups [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.548-1.648; p = 0.572]. Home telemonitoring for Japanese patients with heart failure was feasible; however, beneficial effects in addition to those of usual care were not demonstrated. Further investigation of more patients with severe heart failure, participation of home medical care providers, and use of a more integrated home telemonitoring system emphasizing communication as well as monitoring of symptoms and physiological data are required.

Nurse-Led Collaborative Management Using Telemonitoring Improves Quality of Life and Prevention of Rehospitalization in Patients with Heart Failure

“…12) In the "HOMES-HF" study carried out in Japan, Kotooka stated that one possible reason for non-improvement in the rehospitalization rate was due to the lack of interactive communication. 13) In our study, we provided collaborative support through a nurse and health care workers, rather than only focusing on vital signs. Thus, the effectiveness of telemonitoring seems to be a result of direct interaction with healthcare workers who can arrange and provide comprehensive care for pa-tients.…”

“…One reason for not finding significant benefits of telemonitoring on rehospitalization is the absence of interactive communication between patients and their healthcare providers. 12,13) As most patients with HF are elderly people suffering from comorbid conditions with severe symptoms, they need medical advice and support in their daily household affairs. Hence, we advocated that timely feedback for assessment, appropriate care coordination, and enhancement of patient self-management should be embedded within the alarming system of a telemonitoring program which we considered as collaborative management (CM).…”

Health Care Professionals’ Perceptions of Home Telemonitoring in Heart Failure Care: Cross-Sectional Survey

“…Results from studies are not consistent regarding outcomes of TM. Some studies have shown that TM may improve survival, reduce HF-related hospitalizations, and improve quality of life compared with usual care or low access to care [2,13,14]; other studies have shown no improvements [15-17]. Furthermore, noninvasive TM studies have methodological weaknesses such as insufficiencies regarding large sample size, homogenous protocols, robust designs, a clear definition of noninvasive TM, and show a diversity of outcomes [5,18,19].…”

Status of Medical Care and Management Requirements of Elderly Patients With Heart Failure in a Comprehensive Community Health System ― Survey of General Practitioners’ Views ―

“…23,24 This is thought to be due largely to low adherence to monitoring. A similar telemonitoring study was also performed in Japan; 25 in that study, adherence to monitoring was favorable, owing to the interventions of home healthcare nurses. Unfortunately, there was no significant difference in the readmission rate compared with the usual care group.…”