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Objectives - To identify whether home telemonitoring improves outcomes compared with nurse telephone support and 'usual care' for patients with Heart Failure (HF) who are at high risk of hospitalization or death.

Details - 426 patients with a recent admission for HF and Left Ventricular Ejection fraction (LVEF) (<40%), were assigned randomly to home telemonitoring, nurse telephone support or 'usual care' in a 2:2:1 ratio. Home telemonitoring consisted of twice-daily self-measuring of weight, blood pressure, heart rate, and rhythm with automated devices linked to a cardiology center. The nurse telephone support consisted of specialist nurses who were available to patients by telephone. Primary care physicians delivered "usual care". The primary end point was days dead or hospitalized with nurse support versus home telemonitoring at 240 days.

Results - Of 426 patients randomly assigned, 48% were aged >70 years.

• During 240 days of follow-up, 19.5%, 15.9%, and 12.7% of days were lost as the result of death or hospitalization for usual care, nurse telephone support and home telemonitoring respectively.
• The number of admissions and mortality were similar among patients randomly assigned to nurse telephone support or home telemonitoring, but the mean duration of admissions was reduced by 6 days with home telemonitoring.
• Patients randomly assigned to receive 'usual care' had higher one-year mortality (45%) than patients assigned to receive nurse telephone support (27%) or home telemonitoring (29%) (p = 0.032).

References

• 1. Cleland et al. Noninvasive Home Telemonitoring for Patients With Heart Failure at High Risk of Recurrent Admission and Death. The Trans-European Network-Home-Care Management System (TEN-HMS) study. Journal of American College of Cardiology, 2005; 45:1654-1664, doi:10.1016/j.jacc.2005.01.050.