The effectiveness of remote monitoring of elderly patients after hospitalisation for heart failure: The renewing health European project

Olivari, Zoran; Giacomelli, Sara; Gubian, Lorenzo; Mancin, Silvia; Visentin, Elisa; Francesco, Vincenzo Di; Iliceto, Sabino; Penzo, M.; Zanocco, Albino; Marcon, C.; Anselmi, Maurizio; Marchese, Domenico; Stafylas, Panagiotis

doi:10.1016/j.ijcard.2017.10.099

Cited by 40 publications

(23 citation statements)

References 25 publications

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“…If a hospital admission was required for inclusion, this was most often (n=10) within 7 days of discharge [ 4 , 23 , 24 , 29 , 35 , 37 , 39 - 42 ]. Inclusion was started within 1 month of index hospitalization for 2 studies [ 20 , 25 ], and 5 studies [ 21 , 32 , 43 - 45 ] included patients within 6 months. Most studies (n=12) [ 22 , 26 - 28 , 30 , 31 , 33 , 34 , 36 , 38 , 46 , 47 ] did not specify requirements regarding previous admissions for CHF or included patients from outpatient clinics.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies (n=12) [ 22 , 26 - 28 , 30 , 31 , 33 , 34 , 36 , 38 , 46 , 47 ] did not specify requirements regarding previous admissions for CHF or included patients from outpatient clinics. New York Heart Association (NYHA) Class II was most often reported (n=9) as the NYHA Classification with most patients [ 21 , 22 , 25 , 26 , 28 , 32 , 38 , 45 , 46 ]. NYHA Class III was reported in 8 studies as the dominant class [ 20 , 23 , 29 , 31 , 35 , 43 , 44 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

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The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review

Auener¹,

Remers²,

Dulmen³

et al. 2021

J Med Internet Res

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Background Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review

Auener¹,

Remers²,

Dulmen³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“… 19 Further, it is important for the intervention to be timed with periods of high-risk readmissions (eg, the first 90 days post an index event). Delaying the delivery of RPM devices to patients may reduce the effect 20 (see figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

Factors influencing the effectiveness of remote patient monitoring interventions: a realist review

et al. 2021

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ObjectivesOur recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect; they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions.DesignRealist review—a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015–2020 and used RPM to monitor an individual’s biometric data (eg, heart rate, blood pressure) from a distance.Primary and secondary outcome measuresContextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations).ResultsAcross a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk; (2) accurately detecting a decline in health; (3) providing responsive and timely care; (4) personalising care; (5) enhancing self-management, and (6) ensuring collaborative and coordinated care.ConclusionWhile RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events.PROSPERO registration numberCRD42020142523.

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“…The monitoring of HF patients remotely, or "telemedicine", has already been shown to influence outcomes amongst individuals with HF by improving quality of life, reducing HFrelated hospitalizations, and optimizing the use of the limited resources in this field [18][19][20][21][22]. For example, a wireless implantable hemodynamic monitoring system of PAP allowed better remote HF management and reduced hospitalization rates [23,24].…”

Section: Clinical Implications In Patients With Heart Failurementioning

confidence: 99%

“…Monitoring the impact of therapy remotely holds the potential to reduce HF-related hospitalizations, improve quality of life and optimize the use of the limited resources [17]. Data from clinical trials investigating telemedicine-based interventions are promising, showing improvements in quality of life, and reductions in HF-related hospitalizations and all-cause mortality [18][19][20][21][22]. For example, wireless implantable hemodynamic monitoring systems of pulmonary arty pressure (PAP) allowed better remote HF management and reduced hospitalization rates [23,24].…”

Section: Introductionmentioning

confidence: 99%

Non-invasive vocal biomarker is associated with pulmonary hypertension

et al. 2020

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Emerging data suggest that noninvasive voice biomarker analysis is associated with coronary artery disease. We recently showed that a vocal biomarker was associated with hospitalization and heart failure in patients with heart failure. We evaluate the association between a vocal biomarker and invasively measured indices of pulmonary hypertension (PH). Patients were referred for an invasive cardiac hemodynamic study between January 2017 and December 2018, and had their voices recorded on three separate occasions to their smartphone prior to each study. A pre-established vocal biomarker was determined based on each individual recording. The intra-class correlation coefficient between the separate voice recording biomarker values for each individual participant was 0.829 (95% CI 0.740-0.889) implying very good agreement between values. Thus, the mean biomarker was calculated for each patient. Patients were divided into two groups: high pulmonary arterial pressure (PAP) defined as � 35 mmHg (moderate or greater PH), versus lower PAP. Eighty three patients, mean age 61.6 ± 15.1 years, 37 (44.6%) male, were included. Patients with a high mean PAP (� 35 mmHg) had on average significantly higher values of the mean voice biomarker compared to those with a lower mean PAP (0.74 ± 0.85 vs. 0.40 ± 0.88 p = 0.046). Multivariate logistic regression showed that an increase in the mean voice biomarker by 1 unit was associated with a high PAP, odds ratio 2.31, 95% CI 1.05-5.07, p = 0.038. This study shows a relationship between a noninvasive vocal biomarker and an invasively derived hemodynamic index related to PH obtained during clinically indicated cardiac catheterization. These results may have important practical clinical implications for telemedicine and remote monitoring of patients with heart failure and PH.

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The effectiveness of remote monitoring of elderly patients after hospitalisation for heart failure: The renewing health European project

Cited by 40 publications

References 25 publications

The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review

The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review

Factors influencing the effectiveness of remote patient monitoring interventions: a realist review

Non-invasive vocal biomarker is associated with pulmonary hypertension

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