Exploring the impact of telemonitoring on prescription of guideline-recommended heart failure medication

R. Dierckx, J. Zhang, T. Mabote, P. Pellicori, R. Antony, Yan Zhang, P. Atkin, C. Whitehead, Kevin Goode, John Cleland

    Research output: Contribution to conferenceAbstract

    Abstract

    Background: Home Telemonitoring (HTM) may reduce heart failure (HF) hospitalizations and mortality by improving patient knowledge and compliance, increasing prescription of guideline-based medication or by earlier intervention. HTM of symptoms, heart rate and blood pressure (BP) should facilitate titration of neurohormonal antagonists and diuretics.
    Aims: To assess, in a "real-world" setting, the impact of HTM compared to usual care on prescription of HF medication, by comparing numbers of patients reaching >50% or >100% of target doses of guideline-based medication.
    Methods and results: We retrospectively collected clinical and outcome data on 136 patients (101 men) with HF, referred to a routine NHS HTM service supported by a HF nurse-specialist. Eighty-nine patients (group A) accepted and 47 (group B) refused HTM. In group A, weight, heart rate, BP and symptom severity were measured daily, while group B received usual care. Most patients had moderate to severe HF (36% NYHA class II and 51% class III). Mean age was 71±12 years and ejection fraction 36±12%. Median NTproBNP was 2372 ng/L (IQR: 1059-6343 ng/L). Group B was older (p 0.03) and had lower BMI (p 0.001) and GFR (p 0.01). At referral, respectively 82%, 74%, 10%, 57% and 96% of patients were treated with ß-blockers (BB), ACE-inhibitors (ACE-I), angiotensin receptor blockers (ARB), aldosterone antagonists (ARA) and diuretics, with rates similar in each group. After a mean follow-up of 823±524 days, patients in group A were more likely to receive BB (93% vs 81%, p 0.05). Differences in prescription rates for ACE-I (70% vs 71%), ARB (20% vs 10%) and ARA (64% vs 59%) were similar. However, only 51%, 55% and 59% of patients achieved >50% and only 20%, 32% and 26% achieved >100% of guideline-based target doses of BB, ACE-I/ARB and ARA respectively. The relatively high number of patients with COPD or asthma (29%), renal dysfunction (54%, mean GFR 62±33 ml/min) and high serum potassium (40% with values = 4.5 mmol/L and 13% with values = 5.0 mmol/L) could have deterred increases in HF therapy. Diuretics were more often increased in group A than in group B (p 0.05). During follow-up, rates of all-cause hospitalization and death were similar.

    Conclusion: HTM may improve prescription of key medications for HF but, in routine clinical practice, often may not be sufficient by itself to achieve target doses recommended by guidelines. Service audits, facilitated by decision-support systems, may be required to ensure effective delivery of care. Further research is needed to investigate the reasons for the failure to achieve guideline-target.
    Original languageEnglish
    Number of pages1
    Publication statusPublished - Aug 2013

    Keywords

    • home telemonitoring
    • heart failure
    • medication
    • hospitalisation
    • case studies

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    Dierckx, R., Zhang, J., Mabote, T., Pellicori, P., Antony, R., Zhang, Y., Atkin, P., Whitehead, C., Goode, K., & Cleland, J. (2013). Exploring the impact of telemonitoring on prescription of guideline-recommended heart failure medication. https://academic.oup.com/eurheartj/issue/34/suppl_1