Outcome of patients discharged after an episode of worsening heart failure into a heart failure specialist service supported by home telemonitoring

Yan Zhang, T. Mabote, P. Atkin, C. Whitehead, J. Copsey, M. Walters, Chandra Kambhampati, Darryl N. Davis, Kevin M. Goode, John G. F. Cleland

    Research output: Contribution to conferenceAbstractpeer-review

    Abstract

    Purpose: To describe the outcome of patients in a home telemonitoring (HTM) service for patients with chronic heart failure (CHF). A UK national audit suggests that patients discharged after an episode of worsening heart failure have an overall annual mortality of almost 30% (20% if patients aged > 80 years are excluded). A systematic review suggests that HTM can reduce mortality and possibly hospitalizations for heart failure.
    Methods: HTM was included as part of the local heart failure service provision for the City of Kingston-upon-Hull (population circa 288,000) in 2009 for patients with heart failure considered being at high risk of events based on clinical assessment and plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP). Television Interactive Home Telemonitoring Services are deployed that included monitoring of symptoms, heart rate, blood pressure, and body weight. Results are automatically transmitted to heart failure nurse specialists integral to the service. Most patients were enrolled at discharge after an episode of worsening heart failure. Patients were offered 120 days of monitoring in the first instance. Extensions were offered after re-assessment. The following outcomes were considered for both 120 days and long term follow-up: death from any cause, death or hospitalization for any cause, hospitalization for cardiovascular (CV), and hospitalization for HF.
    Results: Of 219 patients (61 women) enrolled, 57% were aged = 70 years (mean=70 ± 12), mean LVEF was 38 ± 15% and median NTproBNP was 2,029 pg/ml (interquartile range (IQR) 930 to 4,643 pg/ml). Information on longer term follow-up (median = 388 days, IQR 253 to 598 days) was available for 146 patients. At 120 day follow-up, all-cause mortality was 5.9%, death or hospitalization for any cause occurred in 40.1%, CV hospitalization in 36.1% and hospitalization for HF in 17.8%. Kaplan-Meier estimates for all-cause mortality at one year were 10.3%, 63.0% for death or hospitalization for any cause, 60.3% for CV hospitalization and 32.9% for hospitalization for HF.
    Conclusions: Despite good-quality contemporary management from a specialist service and intensive monitoring, the morbidity and mortality of patients with severe and/or unstable heart failure remains high in clinical practice and much worse than suggested by clinical trials. Nonetheless, these outcomes are better than those reported by audits suggesting that HTM may improve outcomes, especially mortality rather than hospitalisation.
    Original languageEnglish
    PagesS35
    Publication statusPublished - May 2012

    Keywords

    • telemedicine
    • remote patient monitoring
    • HTM
    • heart failure
    • case study

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