Utilization of telemedicine by heart disease patients following hospitalization

Abstract

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.

Patient willingness to undergo a two‐week free trial of a telemedicine service for coronary artery disease after coronary intervention: A mixed‐methods study

“…Most previous studies have focused on applied telemedicine services for cardiovascular diseases, such as ECG analysis of ST‐segment elevation myocardial infarction, wherein in‐hospital mortality reduced and the percentage of patients with door‐to‐balloon time lower than 60 min increased (Matsuda et al, ). In addition, results indicated that telemedicine monitoring in patients with repeat percutaneous coronary intervention or cardioversion for atrial fibrillation is more effective in identifying cardiac arrhythmia (Morguet, Kühnelt, Kallel, Rauch, & Schultheiss, ); Furthermore, when telemedicine services are provided, there is a reduction in hospital admission rate, length of stay and mortality in patients with chronic heart failure and higher quality of life scores (Lin et al, ; Wakefield et al, ). Telemedicine combines continuous monitoring and real‐time case manager feedback to more effectively meet patient requirements.…”

“…In addition, results indicated that telemedicine monitoring in patients with repeat percutaneous coronary intervention or cardioversion for atrial fibrillation is more effective in identifying cardiac arrhythmia (Morguet, Kühnelt, Kallel, Rauch, & Schultheiss, 2008); Furthermore, when telemedicine services are provided, there is a reduction in hospital admission rate, length of stay and mortality in patients with chronic heart failure and higher quality of life scores (Lin et al, 2017;Wakefield et al, 2008). Telemedicine combines continuous monitoring and real-time case manager feedback to more effectively meet patient requirements.…”

Mobile Telemonitoring for Arrhythmias in Outpatients in the Republic of Georgia: A Brief Report of a Pilot Study

“…A classical example demonstrating the impact of telemedicine on diagnosis is the event recording of cardiac arrhythmia. [3][4][5] The documentation is a prerequisite for the subsequent diagnosis and therapy. Event recording also enables the correlation between the arrhythmia and the complaints of the patient and allows evaluating the quantity and quality of clinically relevant arrhythmias.…”

Telemedizin in der Kardiologie – Relevanz für die Praxis?!

“…Zu ähnlichen Ergebnissen kommen mittlerweile auch mehrere kontrollierte Studien in Brandenburg [35], Berlin [36], Bayern (München [37] und Fürth [38]) sowie Baden-Württemberg (Heidelberg [13] Die "ideale" Form eines Telemonitorings sollte modular den Gegebenheiten der jeweiligen Situation angepasst werden können, so dass eine reibungslose Überwachung (Abstimmung bezüglich der Schnittstellen) sowohl im stationären als auch im ambulanten Bereich gewährleistet wird, die zusätzlich auch individuell dem Bedarf im Sinne der benötigten Überwachungsfunktionen (Herzfrequenz, Blutdruck, ST-Strecken, Sauerstoffsättigung, Gewicht, Atemfrequenz und Temperatur) und der Intensität des Monitorings (Event-Recording, "on-demand" vs. kontinuierlich) angepasst werden kann. Zukünftig sicherlich sinnvoll wird die integrierte telemedizinische (Mit-)Betreuung eines "primär" kardialen Patienten mit seinen relevanten Komorbiditäten, wie z.B.…”