Dataset Information

Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design.

ABSTRACT:

Background

Telemonitoring, the use of communication technology to monitor clinical status, is gaining attention as a strategy to improve the care of patients with heart failure. A system of frequent monitoring could alert clinicians to early heart failure decompensation, providing the opportunity for intervention before patients become severely ill and require hospitalization. Moreover, patients' participation in a daily monitoring program could have a favorable effect on their health behaviors. The literature on telemonitoring for heart failure, however, is quite limited.

Methods and materials

Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) is a randomized, controlled, trial designed to compare an automated, daily symptom, and self-reported weight monitoring intervention with usual care in reducing (all-cause) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The intervention will be implemented and all outcomes will be assessed over a 6-month period. The purpose of the intervention is to collect information about symptoms, clinical status and weight and to engage participants in their own self-care. Participants are recruited from general cardiology, heart failure specialty, and primary care practices across the United States.

Conclusions

The results of this study may inform future policy decisions regarding implementation of telemonitoring in treatment of heart failure.

SUBMITTER: Chaudhry SI

PROVIDER: S-EPMC2702538 | biostudies-literature | 2007 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design.

Chaudhry Sarwat I SI Barton Barbara B Mattera Jennifer J Spertus John J Krumholz Harlan M HM

Journal of cardiac failure 20071101 9

<h4>Background</h4>Telemonitoring, the use of communication technology to monitor clinical status, is gaining attention as a strategy to improve the care of patients with heart failure. A system of frequent monitoring could alert clinicians to early heart failure decompensation, providing the opportunity for intervention before patients become severely ill and require hospitalization. Moreover, patients' participation in a daily monitoring program could have a favorable effect on their health be ...[more]

PMID: 17996818

Similar Datasets

Project description:BackgroundRecent studies show an association between neighborhood-level measures of socioeconomic status (SES) and outcomes for patients with heart failure. We do not know whether neighborhood SES has a primary effect or is a marker for individual SES.Methods and resultsWe used the data from participants of the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, recruited from 33 US internal medicine and cardiology practices and examined the association between neighborhood SES and outcomes of patients with heart failure. We used census tracts as proxies for neighborhoods and constructed summary SES scores that included information about wealth and income, education, and occupation. The primary end points were readmission and all-cause mortality at 6 months. We conducted patient interviews and medical chart reviews to obtain demographic information, clinical factors, therapies, and individual SES. We included 1557 patients: 524, 516, and 517 from low, medium, and high SES neighborhoods, respectively (mean age, 61.1±15.2 years; 42.2% women).Overall, 745 patients (47.8%) had ≥1 readmission and 179 patients (11.5%) died. When compared with patients in high SES neighborhoods, those living in low-SES neighborhoods were more likely to be readmitted (odds ratio, 1.35; 95% confidence interval, 1.01-1.82), but the mortality rates were not significantly different (odds ratio, 0.78; 95% confidence interval, 0.50-1.18). The results were consistent after multivariable adjustments for individual demographics, clinical factors, and individual SES.ConclusionsAmong patients with heart failure, neighborhood SES was significantly associated with 6-month all-cause readmission even after adjusting for other patient-level factors, including individual SES. Greater number of events and longer follow-up is required to ascertain the potential effect of neighborhood SES on mortality.Clinical trial registration urlhttp://clinicaltrials.gov/. Unique identifier: NCT00303212.

Project description:Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined.The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes.One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients' mobile phones and alerts to a cardiologist's mobile phone as required.Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics.Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones.ClinicalTrials.gov NCT00778986.

Dataset Information

Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design.

Background

Methods and materials

Conclusions

Publications

Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets