Objective: We investigated in a pilot study whether telemedicine is beneficial in mild to moderate chronic heart failure. Methods: A total of 128 patients with an ejection fraction ≤60% and NYHA class II or III chronic heart failure were evaluated. Thirty-two patients were enrolled prospectively in a staged telemedical service program. Ninety-six controls were matched 3:1 to each telemedicine patient. Results: Median follow-up was 307 days (range 104–459). All-cause hospitalization duration [317 vs. 693 days/100 patient years; relative risk (RR) 0.46; 95% confidence interval (CI) 0.37–0.58; p < 0.0001) and rate (38 vs. 77/100 patient years; RR 0.49; 95% CI 0.25–0.95; p = 0.034) as well as cardiac hospitalization duration (49 vs. 379 days/100 patient years; RR 0.13; 95% CI 0.08–0.23; p < 0.0001] were significantly lower, cardiac hospitalization rate (11 vs. 35/100 patient years; RR 0.31; 95% CI 0.11–1.02; p = 0.058) tended to be lower in the telemedicine compared with the control group. Conclusion: These preliminary data suggest that telemedical care and monitoring may reduce morbidity in patients with NYHA class II and III chronic heart failure.

NYHA class III and IV chronic heart failure has been established as a potential indication for telemedical care and monitoring already. We conducted a prospective study to assess the utilization of telemedical services by cardiac patients in order to identify further indications. A total of 540 patients (mean age 59 years) with various heart diseases participated for at least 30 days in a home-based telemedicine service programme. The two primary outcome measures were the rates of symptom-driven telephone calls (A) and ECG transmissions (B) per patient-year. The total follow-up was 68,649 days, with a median of 93 days. Symptomatic patients placed 713 calls and transmitted 221 ECGs. Poisson regression analysis with subset selection yielded four significant (P < 0.05) independent positive predictors of the use of the telemedicine service: (1) recent repeat (at least one previous) percutaneous coronary intervention (A, P = 0.010; B, P = 0.001); (2) recent cardioversion for atrial fibrillation or flutter (A, P < 0.0001; B, P < 0.0001); (3) ejection fraction (A, P = 0.012; B, P > 0.05); and (4) reciprocal of age (A, P < 0.0001; B, P > 0.05). These data suggest that telemedicine may benefit patients following repeat percutaneous coronary intervention or cardioversion for atrial fibrillation. Since patients availed themselves of telemedicine service less with deteriorating ejection fraction and increasing age, individuals with chronic heart failure will need dedicated programmes, especially when they are older.

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