The AMULET ménage à trois: nurse, telemedicine support, and remote cardiologist

Abstract

This article refers to 'Effects of an outpatient intervention comprising nurse-led non-invasive assessments, telemedicine support and remote cardiologists' decisions in patients with heart failure (AMULET study): a randomised controlled trial' by P. Krzesi ński et al., published in this issue on pages 565-577.When considering telemedicine in heart failure (HF), we have in mind remote patient monitoring with a daily transfer of vital parameters from patient's home to caregivers. The main purpose of this approach is the prevention of HF hospitalizations due to early detection of a cardiac decompensation and an immediate response. The concept of home telemonitoring was investigated in several randomized controlled trials (RCTs) using different invasive and non-invasive devices. The results of these RCTs are inconsistent (Table 1).AMULET was a multicentre, prospective, randomized, open-label, controlled, parallel group trial investigating the efficacy of a telecare model based on nurse-led outpatient service at so-called 'ambulatory care points' (ACPs). 10 The study was performed in nine sites in Poland between March 2018 and October 2020.The basic concept of the AMULET telecare model is a nurse-led HF outpatient service combined with telemedical support by a cardiologist. The nurses assessed HF signs and symptoms during seven outpatient visits during 12 months of follow-up at the ACP. During these visits, additional vital parameters -heart rate, blood pressure, thoracic fluid content, body mass and total body water -were measured using body impedance and impedance cardiography techniques. All information obtained was sent to a cardiologist using web modules including recommendation support to allow clinical interpretation of visit-to-visit changes of the body impedance and haemodynamic parameters. Resulting therapeutic decisions made by the cardiologists were sent back to the nurses. The nurses provided this information to the patients and recommended to follow this advice.