A pilot study of nurse-led, home-based telecardiology for patients with chronic heart failure

Abstract

We assessed the feasibility of home-based telecardiology for patients with chronic heart failure (CHF). Seventy-four CHF patients were enrolled into a programme of telephone follow-up and single-lead electrocardiography (ECG) monitoring. The patients transmitted their ECG data by fixed telephone line to a receiving station, where a nurse was available for an interactive teleconsultation. Patients were followed up for a mean (SD) of 307 (108) days; 1467 calls were analysed (213 ad hoc consultations and 1254 scheduled consultations). A total of 124 cardiovascular events were recorded. Modifications to therapy were suggested in response to 119 calls; hospital admissions were suggested for 13 patients, further investigations for 7 and a consultation with the patient's general practitioner for 13. No action was taken after 1330 calls. Twenty-two ECG abnormalities were recorded. In 63 patients receiving the beta-blocker carvedilol, the mean dosage increased from 36 to 42 mg. In the previous year there were 1.8 hospitalizations per patient, while in the follow-up period there were 0.2 hospitalizations per patient. Following up CHF patients using a nurse-led telecardiology programme seems to be feasible and useful.

Clinical and Psycological Telemonitoring and Telecare of High Risk Patientswith Chronic Heart Failure through Wireless Technologies: The Icaros Project

“…Bearing in mind that we did not include patients with relevant social and cognitive problems, our coort of elderly patients used the PDA with ease and accepted the device; in fact only one of them refused to continue the study. In ICAROS, we used a nurse-based approach, similarly to what has been proposed by most studies [9,12,14,19,24]: the cardiologist was involved by the nurse when appropriate.…”

“…A final consideration is that telemonitoring does not imply telecare: this may explain the failure of some ambitious, multicenter studies [20,21] and the better results coming from local experiences, where patients were most likely to benefit from an individually tailored interaction with dedicated, well-trained and highly specialized care providers [19,23,24]. In other words, without a spoonful of human touch, plain telemonitoring and telecare, although homogeneously provided following predetermined flow-charts, is probably costly an poorly effective [23,24,39].…”

“…In other words, without a spoonful of human touch, plain telemonitoring and telecare, although homogeneously provided following predetermined flow-charts, is probably costly an poorly effective [23,24,39].…”

“…After TEMISTOCLE, a network for the integrated management of patients with chronic, stable heart failure has been developed in Italy, with favorable preliminary results [23][24][25][26]. To fill the gap between these models of home-based care for stable patients, and the hospital-based care for acute and sicker patients, we designed the ICAROS project (Integrated care vs Conventional intervention in cArdiac failure patients: Randomized Open label Study), in which the clinical approach of heart failure specialists was integrated with Internet and wireless technologies with the aim of developing a decision-making model that could fit the needs of fragile patients [27].…”

Development of Physiological Parameters Monitoring System using the Internet of Things

“…The traditional medical diagnosis mode (face to face) cannot satisfy people' requirements [1]. In order to solve this issue, the concept of telemedicine is proposed.…”