A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home‐HF study

Abstract

Aims Heart failure chiefly affects the elderly, with frequent emergency admissions. Telemonitoring can identify worsening heart failure but previous randomized trials have enrolled selected patient populations. The Home‐HF study examined the impact of home telemonitoring on typical heart failure patients discharged from three acute hospitals in North West London, UK. Methods and results Patients hospitalized with heart failure were randomized to telemonitoring or usual specialist care. Primary outcome measures were days alive and out of hospital. Secondary outcome measures were number and duration of heart failure hospitalizations, clinic visits, and quality of life. We recruited 182 patients. There was no difference in the primary outcome measure in the two groups, but there were significantly fewer unplanned hospitalizations for heart failure decompensation, and a reduction in clinic and emergency room visits in the telemonitoring group. There was no statistically significant difference in the mean direct health service costs. Conclusion Home telemonitoring in a typical elderly population of heart failure patients produces a similar outcome to ‘usual’ specialist care, but reduces clinic and emergency room visits and unplanned heart failure rehospitalizations at little additional cost. This method of disease monitoring may allow specialist services to increase the number of patients under their care.

Technology and its role in respiratory care

“…In a recent heart failure study, technology was perceived to have a reduced impact due to the high quality of standard care by the outreach heart failure nursing team. 48 Cowie and colleagues' findings concur with other research on the effect of multidisciplinary teams (MDTs) which demonstrate that when best practice is operationalised there may not be a need for additional services. 49 Whilst technology may assist in the management of patients alongside best practice, it remains to be seen if there is a reduction in mortality, morbidity -and conversely an increase in quality of life -that can be solely assigned to the addition of technology.…”

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

“…Barker et al, 71 2012 X Naylor et al, 35 2004 X Kwok et al, 72 2008 X Nucifora et al, 59 2006 X X 8 RCTs combined a structured telephone call with follow-up in a clinic. 44 47,66 The vital signs transmitted daily consisted of weight, 47,66 blood pressure, pulse, and oxygen saturation. 66 Patients also answered questions on CHF symptoms via telephone (automated voice response).…”

“…Sixteen RCTs described blinding of outcome assessors* and 5 reported some level of allocation concealment. 8,10,55,62,66 Loss to follow-up was acceptable (less than 20%) in 35 RCTs. …”

A critical review on telemonitoring in heart failure

“…On the other hand, patients in Tele-HF recruited after a shorter time interval following an acute event, had a lower rate of guideline-mandated medications and a higher event rate, but again and in contrast to the findings of the metaanalyses, no significant effect was found. Comparable findings were seen in a smaller recent study performed in the United Kingdom, the Home-HF study 17 , which randomized 182 elderly patients comparing UC (but with one initial home visit by the study nurse) and telemonitoring. Primary outcome, days alive and out of hospital were similar in both groups.…”