1
|
Kokkonen J, Mustonen P, Heikkilä E, Leskelä RL, Pennanen P, Krühn K, Jalkanen A, Laakso JP, Kempers J, Väisänen S, Torkki P. Effectiveness of Telemonitoring in Reducing Hospitalization and Associated Costs for Patients With Heart Failure in Finland: Nonrandomized Pre-Post Telemonitoring Study. JMIR Mhealth Uhealth 2024; 12:e51841. [PMID: 38324366 PMCID: PMC10896481 DOI: 10.2196/51841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/24/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Many patients with chronic heart failure (HF) experience a reduced health status, leading to readmission after hospitalization despite receiving conventional care. Telemonitoring approaches aim to improve the early detection of HF decompensations and prevent readmissions. However, knowledge about the impact of telemonitoring on preventing readmissions and related costs remains scarce. OBJECTIVE This study assessed the effectiveness of adding a telemonitoring solution to the standard of care (SOC) for the prevention of hospitalization and related costs in patients with HF in Finland. METHODS We performed a nonrandomized pre-post telemonitoring study to estimate health care costs and resource use during 6 months on SOC followed by 6 months on SOC with a novel telemonitoring solution. The telemonitoring solution consisted of a digital platform for patient-reported symptoms and daily weight and blood pressure measurements, automatically generated alerts triggering phone calls with secondary care nurses, and rapid response to alerts by treating physicians. Telemonitoring solution data were linked to patient register data on primary care, secondary care, and hospitalization. The patient register of the Southern Savonia Social and Health Care Authority (Essote) was used. Eligible patients had at least 1 hospital admission within the last 12 months and self-reported New York Heart Association class II-IV from the central hospital in the Southern Savonia region. RESULTS Out of 50 recruited patients with HF, 43 completed the study and were included in the analysis. The hospitalization-related cost decreased (49%; P=.03) from €2189 (95% CI €1384-€2994; a currency exchange rate of EUR €1=US $1.10589 is applicable) during SOC to €1114 (95% CI €425-€1803) during telemonitoring. The number of patients with at least 1 hospitalization due to HF was reduced by 70% (P=.002) from 20 (47%) out of 43patients during SOC to 6 (14%) out of 43 patients in telemonitoring. The estimated mean total health care cost per patient was €3124 (95% CI €2212-€4036) during SOC and €2104 (95% CI €1313-€2895) during telemonitoring, resulting in a 33% reduction (P=.07) in costs with telemonitoring. CONCLUSIONS The results suggest that the telemonitoring solution can reduce hospital-related costs for patients with HF with a recent hospital admission.
Collapse
Affiliation(s)
| | - Pirjo Mustonen
- The Wellbeing Services County of Southwest Finland, Turku, Finland
| | | | | | | | - Kati Krühn
- Roche Diagnostics (Schweiz) AG, Zug, Switzerland
| | - Arto Jalkanen
- The Wellbeing Services County of South Savo, Mikkeli, Finland
| | | | - Jari Kempers
- European Health Economics Oy, Jyväskylä, Finland
| | | | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Wintrich J, Pavlicek V, Brachmann J, Bosch R, Butter C, Oswald H, Rybak K, Millenaar D, Mahfoud F, Böhm M, Ukena C. Differences in management of telemedicine alerts on weekdays and public holidays: Results from the OptiLink heart failure trial. J Telemed Telecare 2024; 30:173-179. [PMID: 34524925 DOI: 10.1177/1357633x211039398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the OptiLink heart failure study, timely and appropriate reactions to telemedicine alerts improved clinical outcomes in heart failure patients. This analysis investigates the relation between the weekday of alert transmission and the subsequent patient contact. METHODS In patients enrolled in the intervention arm of the OptiLink heart failure study (n = 505, age 66.1 ± 10.1, 77.2% male, left-ventricular ejection fraction 26.7% ± 6.1%), fluid index threshold crossing alerts were analysed according to the weekday of the transmission. Transmissions on Mondays-Thursdays were categorized as TD1, Fridays-Sundays as well as public holidays as TD2. RESULTS Of 1365 transmitted alerts, 867 (63.5%) were categorized as TD1 and 498 (36.5%) as TD2. Same day telephone contacts were more frequent in TD1 (46.2%) than in TD2 (18.3%; p < 0.001). Accordingly, the median time to contact was significantly longer in TD2 compared with TD1 (2(1-3) vs 0(0-1) days; p < 0.001). Rates of no telephone contact were no different between the groups (12.1% vs 12.4%; p = 0.866). Although signs of worsening heart failure were prevalent in 32.4% in TD1 versus 32.1% in TD2 (p = 0.996), initiation of a pharmacological intervention occurred more likely in TD1 compared with TD2 (27.9% vs 22.9%; p = 0.041). No differences existed concerning hospitalization for heart failure within 30 days after alert transmission (3.9% vs 3.4%; p = 0.636). CONCLUSION Alert transmissions during weekends and public holidays were less likely associated with timely patient contacts and initiation of pharmacological interventions than during the week. Telemedical centres providing 24/7 remote monitoring service and specific education programmes for physicians might help to optimize patient care.
Collapse
Affiliation(s)
- Jan Wintrich
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany
| | - Valerie Pavlicek
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany
| | - Johannes Brachmann
- Department of Internal Medicine II, Cardiology, Angiology and Pneumology, Klinikum Coburg GmbH, Germany
| | - Ralph Bosch
- Cardio Centrum Ludwigsburg-Bietigheim, Germany
| | - Christian Butter
- Immanuel Herzzentrum Brandenburg, Bernau, Germany
- Medizinische Hochschule Brandenburg, Germany
| | - Hanno Oswald
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Halle (Saale), Germany
| | - Karin Rybak
- Kardiologische Praxis Dessau, Dessau, Germany
| | - Dominic Millenaar
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany
| |
Collapse
|
3
|
Fredericks S, Bae T, Sochaniwskyj M, Sanders J, Martorella G, Wynne R. Creating a social media strategy for an international cardiothoracic research network: a scoping review. Eur J Cardiovasc Nurs 2023; 22:751-757. [PMID: 36802352 DOI: 10.1093/eurjcn/zvad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023]
Abstract
AIMS A cardiac surgery international nursing and allied professional research network titled CONNECT was created to strengthen collaborative cardiac surgery research through shared initiatives including supervision, mentorship, workplace exchange programs, and multi-site clinical research. As with any new initiative, there is a need to build brand awareness to enhance user familiarity, grow membership, and promote various opportunities offered. Social media has been used across various surgical disciplines; however, their effectiveness in promoting scholarly and academic-based initiatives has not been examined. The aim of this scoping review was to examine the different types of social media platforms and strategies used to promote cardiac research initiatives for CONNECT. METHODS AND RESULTS A scoping review was undertaken in which a comprehensive and thorough review of the literature was performed. Fifteen articles were included in the review. Twitter appeared to be the most common form of social media used to promote cardiac initiatives, with daily posts being the most frequent type of engagement. Frequency of views, number of impressions and engagement, link clicks, and content analysis were the most common types of evaluation metrics that were identified. CONCLUSION Findings from this review will inform the design and evaluation of a targeted Twitter campaign aimed at increasing brand awareness of CONNECT, which will include the use of @CONNECTcardiac Twitter handle, hashtags, and CONNECT-driven journal clubs. In addition, the use of Twitter to disseminate information and brand initiatives related to CONNECT will be evaluated using the Twitter Analytics function. REGISTRATION Open Science Framework: osf.io/q54es.
Collapse
Affiliation(s)
- Suzanne Fredericks
- Daphne Cockwell School of Nursing, Toronto Metropolitan University - M5B 2K3, 350 Victoria St., Toronto, ON, Canada
| | - Tammy Bae
- Daphne Cockwell School of Nursing, Toronto Metropolitan University - M5B 2K3, 350 Victoria St., Toronto, ON, Canada
| | - Mark Sochaniwskyj
- Daphne Cockwell School of Nursing, Toronto Metropolitan University - M5B 2K3, 350 Victoria St., Toronto, ON, Canada
| | - Julie Sanders
- St. Bartholomew Hospital - W Smithfield, Barts Health NHS Trust and Clinical Professor of Cardiovascular Nursing, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, Queen Mary University - Mile End Rd, Bethnal Green, London E1 4NS, UK
| | - Geraldine Martorella
- College of Nursing, Florida State University; Office 104F-Vivian M. Duxbury Hall; TMH Center for Research and Evidence-Based Practice, 98 Varsity Way, 32306 Tallahassee, FL, USA
| | - Rochelle Wynne
- Cardiothoracic Surgery, The Royal Melbourne Hospital, 300 Grattan Street (corner of Royal Parade), Parkville, Victoria 3050, Australia
| |
Collapse
|
4
|
Le Goff-Pronost M, Bongiovanni-Delarozière I. Economic evaluation of remote patient monitoring and organizational analysis according to patient involvement: a scoping review. Int J Technol Assess Health Care 2023; 39:e59. [PMID: 37750813 DOI: 10.1017/s0266462323002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND A literature review concerning the economic evaluation of telemonitoring was requested by the authority in charge of health evaluation in France, in a context of deployment of remote patient monitoring and identification of its financing. Due to the heterogeneity of existing telemonitoring solutions, it was necessary to stratify the evaluation according to patient involvement. Three levels of patient involvement are considered: weak (automated monitoring), medium (monitoring supported by a professional), and strong (active remote participation). OBJECTIVES We performed a scoping review to provide a comprehensive overview of different systems of telemonitoring and their reported cost-effectiveness. METHODS Following PRISMA-ScR guidelines, a search was performed in four databases: PubMed, MEDLINE, EMBASE, and Cochrane Library between January 1, 2013 and May 19, 2020. Remote patient monitoring should include the combination of three elements: a connected device, an organizational solution for data analysis and alert management, and a system allowing personalized interactions, and three degrees of involvement. RESULTS We identified 61 eligible studies among the 489 records identified. Heart failure remains the pathology most represented in the studies selected (n = 24). The cost-utility analysis was chosen in a preponderant way (n = 41). Forty-four studies (72 percent) reported that the intervention was expected cost-effective. Heterogeneity has been observed in the remote monitoring solutions but all systems are reported cost-effective. The small number of long-term studies does not allow conclusions to be drawn on the transposability. CONCLUSIONS Remote patient monitoring is reported to be cost-effective whatever the system and patient involvement.
Collapse
|
5
|
Lee KCS, Breznen B, Ukhova A, Martin SS, Koehler F. Virtual healthcare solutions in heart failure: a literature review. Front Cardiovasc Med 2023; 10:1231000. [PMID: 37745104 PMCID: PMC10513031 DOI: 10.3389/fcvm.2023.1231000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.
Collapse
Affiliation(s)
| | - Boris Breznen
- Evidence Synthesis, Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | | | - Seth Shay Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Friedrich Koehler
- Deutsches Herzzentrum der Charité (DHZC), Centre for Cardiovascular Telemedicine, Campus Charité Mitte, Berlin, Germany
- Division of Cardiology and Angiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
6
|
Stremmel C, Breitschwerdt R. Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review. JMIR Cardio 2023; 7:e44983. [PMID: 37647103 PMCID: PMC10500361 DOI: 10.2196/44983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. OBJECTIVE After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). METHODS We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. RESULTS Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. CONCLUSIONS Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.
Collapse
|
7
|
Ding X, Wen Y, Tian Z, Wen Y, Sun G, Geng R, Fang W, Xu Y. Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis. Front Cardiovasc Med 2023; 9:1053765. [PMID: 36824289 PMCID: PMC9941331 DOI: 10.3389/fcvm.2022.1053765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
Objective The aim of this meta-analysis was to assess the impact of e-health interventions on disease management in patients with CHF. Methods Six databases including Embase, Web of Science, Scopus, PubMed, Cochrane, and EBSCO were searched by computer. The search time is before May 1, 2022. Odds ratios (OR) were used for binary categorical data and weighted mean differences (WMD) for continuous variables. The 95% confidence intervals (CI) were used to express the effect sizes for both count and measurement data. RevMan 5.4 and Stata 16.0 were employed to complete this meta-analysis. Results The study included 22 research studies and 5,149 patients. e-health intervention can effectively reduce all-cause mortality [OR = 0.801, 95%CI: (0.650, 0.987), P < 0.05], all-cause hospitalization rate [OR = 0.66, 95%CI: (0.46, 0.95), P < 0.05] and heart failure related hospitalization rate [OR = 0.750, 95%CI: (0.632, 0.891), P < 0.05]. e-health intervention is also effective in improving the quality of life [WMD = 2.97, 95%CI: (1.54, 4.40), P < 0.05] and the self-management ability of patients [WMD = -2.76, 95%CI: (-5.52, -0.11), P < 0.05]. Conclusion e-health interventions can reduce all-cause mortality, all-cause hospitalization, and heart failure-related hospitalization in patients with CHF. Furthermore, it can improve the health-related quality of life of patients.
Collapse
Affiliation(s)
- Xueying Ding
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Yating Wen
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Zimeng Tian
- College of Integrated Chinese and Western Medicine, Jining Medical University, Jining, Shandong, China
| | - Yaru Wen
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Guokun Sun
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Rongxing Geng
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Wei Fang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Yun Xu
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China,*Correspondence: Yun Xu ✉
| |
Collapse
|
8
|
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial. JACC. HEART FAILURE 2023; 11:191-206. [PMID: 36718715 DOI: 10.1016/j.jchf.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The randomized INH (Interdisciplinary Network Heart Failure) trial (N = 715) reported that 6 months' remote patient management (RPM) (HeartNetCare-HF) did not reduce the primary outcome (time to all-cause death/rehospitalization) vs usual care (UC) in patients discharged after admission for acute heart failure, but suggested lower mortality and better quality of life in the RPM group. OBJECTIVES The Extended (E)-INH trial investigated the effects of 18 months' HeartNetCare-HF on the same primary outcome in an expanded population (N = 1,022) and followed survivors up to 60 months (primary outcome events) or up to 120 months (mortality) after RPM termination. METHODS Eligible patients aged ≥18 years, hospitalized for acute heart failure, and with predischarge ejection fraction ≤40% were randomized to RPM (RPM+UC; n = 509) or control (UC; n = 513). Follow-up visits were every 6 months during RPM, and then at 36, 60, and 120 months. RESULTS The primary outcome did not differ between groups at 18 months (60.7% [95% CI: 56.5%-65.0%] vs 61.2% [95% CI: 57.0%-65.4%]) or 60 months (78.1% [95% CI: 74.4%-81.6%] vs 82.8% [95% CI: 79.5%-86.0%]). At 60 and 120 months, all-cause mortality was lower in patients previously undergoing RPM (41.1% [95% CI: 37.0%-45.5%] vs 47.4% [95% CI: 43.2%-51.8%]; P = 0.040 and 64.0% [95% CI: 59.8%-68.2%] vs 69.6% [95% CI: 65.6%-73.5%]; P = 0.019). At all visits, health-related quality of life was better in patients exposed to HeartNetCare-HF vs UC. CONCLUSIONS Although 18 months' HeartNetCare-HF did not significantly reduce the primary outcome of death or rehospitalization at 60 months, lower 120-month mortality in patients previously undergoing HeartNetCare-HF suggested beneficial longer-term effects, although the possibility of a chance finding remains.
Collapse
|
9
|
Caillon M, Sabatier R, Legallois D, Courouve L, Donio V, Boudevin F, de Chalus T, Hauchard K, Belin A, Milliez P. A telemonitoring programme in patients with heart failure in France: a cost-utility analysis. BMC Cardiovasc Disord 2022; 22:441. [PMID: 36217130 PMCID: PMC9549824 DOI: 10.1186/s12872-022-02878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. METHODS A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three 'not hospitalised' states, two 'hospitalisation for heart failure' states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. RESULTS The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. CONCLUSIONS Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.
Collapse
Affiliation(s)
| | - Rémi Sabatier
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
| | | | | | | | | | | | - Annette Belin
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Paul Milliez
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
| |
Collapse
|
10
|
Al Sattouf A, Farahat R, Khatri AA. Effectiveness of Transitional Care Interventions for Heart Failure Patients: A Systematic Review With Meta-Analysis. Cureus 2022; 14:e29726. [PMID: 36340534 PMCID: PMC9621739 DOI: 10.7759/cureus.29726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Heart failure is a leading cause of hospitalizations. Heart failure patients were found to have a high incidence of re-admission after discharge. This highlights a care gap during the transition from hospital to home environment and interventions were utilized to cover this care gap. The aim of this review was to evaluate the effectiveness of these interventions. This was investigated in terms of re-admissions, mortality, emergency department (ED) visits, and quality of life. An exhaustive systematic search was conducted in electronic databases, which include MEDLINE, CINAHL, AMED, Cochrane library, and PubMed. Databases were explored for literature published in English between April 2012 and April 2022. The review included 13 randomized controlled trials and comprised a total of 7,693 heart failure patients with 3,835 receiving transitional care interventions (TCIs) and 3,858 receiving standard care. It was found that implementing TCIs resulted in a reduction of all-cause re-admission and all-cause mortality. Although it is controversial if TCIs improve quality of life, TCIs were noted to decrease the frequency of ED visits. Telephone support interventions proved most efficacious among other interventions in reducing hospital readmissions, and were found effective in reducing mortality in combination with other interventions, i.e. clinic visits. Additionally, telemonitoring is found beneficial in supporting patients just after discharge, the most vulnerable period, for medically optimizing and monitoring patients during the care gap.
Collapse
|
11
|
Kuan PX, Chan WK, Fern Ying DK, Rahman MAA, Peariasamy KM, Lai NM, Mills NL, Anand A. Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis. Lancet Digit Health 2022; 4:e676-e691. [PMID: 36028290 PMCID: PMC9398212 DOI: 10.1016/s2589-7500(22)00124-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 10/29/2022]
|
12
|
Wong CK, Un KC, Zhou M, Cheng Y, Lau YM, Shea PC, Lui HW, Zuo ML, Yin LX, Chan EW, Wong ICK, Sin SWC, Yeung PPN, Chen H, Wibowo S, Wei TLN, Lee SM, Chow A, Tong RCF, Hai J, Tam FCC, Siu CW. Daily ambulatory remote monitoring system for drug escalation in chronic heart failure with reduced ejection fraction: pilot phase of DAVID-HF study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:284-295. [PMID: 36713022 PMCID: PMC9708020 DOI: 10.1093/ehjdh/ztac024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/27/2022] [Accepted: 04/11/2022] [Indexed: 05/04/2023]
Abstract
AIMS Underutilization of guideline-directed heart failure with reduced ejection fraction (HFrEF) medications contributes to poor outcomes. METHODS AND RESULTS A pilot study to evaluate the safety and efficacy of a home-based remote monitoring system for HFrEF management was performed. The system included wearable armband monitors paired with the smartphone application. An HFrEF medication titration algorithm was used to adjust medication daily. The primary endpoint was HFrEF medication utilization at 120 days. Twenty patients (60.5 ± 8.2 years, men: 85%) with HFrEF were recruited. All received angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI) at recruitment; 45% received ≥50% maximal targeted dose (MTD) with % MTD of 44.4 ± 31.7%. At baseline, 90 and 70% received beta-adrenergic blocker and mineralocorticoid receptor antagonist (MRA), 35% received ≥50% MTD beta-adrenergic blocker with % MTD of 34.1 ± 29.6%, and 25% received ≥50% MTD MRA with % MTD of 25.0 ± 19.9%. At 120 days, 70% received ≥50% MTD ACEI/ARB/ARNI (P = 0.110) with % MTD increased to 64.4 ± 33.5% (P = 0.060). The proportion receiving ≥50% MTD ARNI increased from 15 to 55% (P = 0.089) with % MTD ARNI increased from 20.6 ± 30.9 to 53.1 ± 39.5% (P = 0.006*). More patients received ≥50% MTD MRA (65 vs. 25%, P = 0.011*) with % MTD MRA increased from 25.0 ± 19.9 to 46.2 ± 28.8% (P = 0.009*). Ninety-five per cent of patients had reduced NT-proBNP with the percentage reduction of 26.7 ± 19.7%. CONCLUSION Heart failure with reduced ejection fraction medication escalation with remote monitoring appeared feasible.
Collapse
Affiliation(s)
- Chun Ka Wong
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ka Chun Un
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mi Zhou
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yangyang Cheng
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuk Ming Lau
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Puigi Catherine Shea
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hin Wai Lui
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ming Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Li Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Simon Wai Ching Sin
- Respiratory Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Pauline Pui Ning Yeung
- Respiratory Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hao Chen
- Biofourmis Singapore Pte Ltd, Singapore, Singapore
| | - Sandi Wibowo
- Biofourmis Singapore Pte Ltd, Singapore, Singapore
| | | | | | | | | | - Jojo Hai
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Frankie Chor Cheung Tam
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung Wah Siu
- Corresponding author. Tel: +86 (852) 2255 4694, Fax: +86 (852) 2818 6304,
| |
Collapse
|
13
|
Morken IM, Storm M, Søreide JA, Urstad KH, Karlsen B, Husebø AML. Posthospitalization Follow-Up of Patients With Heart Failure Using eHealth Solutions: Restricted Systematic Review. J Med Internet Res 2022; 24:e32946. [PMID: 35166680 PMCID: PMC8889479 DOI: 10.2196/32946] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden, and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life (QoL), and reduce readmission rates during the transition between hospital and home. OBJECTIVE The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care, QoL, and readmissions. METHODS A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S) Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL, MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included studies' methodological quality. A thematic analysis method was used to analyze data extracted from the studies. RESULTS A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56% (10/18) of them published in the United States. Of the 18 studies, 16 (89%) were randomized controlled trials, and 14 (78%) recruited patients upon hospital discharge to eHealth interventions lasting from 14 days to 12 months. The studies involved structured telephone calls, interactive voice response, and telemonitoring and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vital signs. Of the 18 studies, 11 (61%) provided information on patient adherence, and the adherence levels were 72%-99%. When used for posthospitalization follow-up of patients with HF, eHealth interventions can positively affect QoL, whereas its impact is less evident for self-care and readmissions. CONCLUSIONS This review suggests that patients with HF should receive prompt follow-up after hospitalization and eHealth interventions have the potential to improve these patients' QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further studies are warranted to examine the effects of eHealth interventions on self-care and readmissions among patients with HF.
Collapse
Affiliation(s)
- Ingvild Margreta Morken
- Department of Quality and Health Technologies, University of Stavanger, Stavanger, Norway
- Research Group for Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kristin Hjorthaug Urstad
- Department of Quality and Health Technologies, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bjørg Karlsen
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Anne Marie Lunde Husebø
- Research Group for Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| |
Collapse
|
14
|
Gruwez H, Bakelants E, Dreesen P, Broekmans J, Criel M, Thomeer M, Vandervoort P, Ruttens D. Remote patient monitoring in COVID-19: a critical appraisal. Eur Respir J 2022; 59:59/2/2102697. [PMID: 35115396 PMCID: PMC8812467 DOI: 10.1183/13993003.02697-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/20/2021] [Indexed: 11/05/2022]
Abstract
With great interest, we read the article by Grutterset al. [1], in which they share their results of the largest patient cohort of coronavirus disease 2019 (COVID-19) home monitoring to date. Based on these results, remote patient monitoring (RPM) was praised and was claimed as a tool to reduce the hospital stay of COVID-19 patients by 5 days. Is there any evidence for #telemonitoring in #COVID19? Read more:https://bit.ly/3p1YXBi
Collapse
Affiliation(s)
- Henri Gruwez
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.,Dept of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.,Dept of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Emma Bakelants
- Faculty of Medicine, University of Leuven, Leuven, Belgium.,Dept of Respiratory Medicine, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Pauline Dreesen
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | | | - Maarten Criel
- Dept of Respiratory Medicine, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Michiel Thomeer
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.,Dept of Respiratory Medicine, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Pieter Vandervoort
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.,Dept of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - David Ruttens
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium .,Dept of Respiratory Medicine, Ziekenhuis Oost Limburg, Genk, Belgium
| |
Collapse
|
15
|
Mohammadzadeh N, Rezayi S, Tanhapour M, Saeedi S. Telecardiology interventions for patients with cardiovascular Disease: A systematic review on characteristics and effects. Int J Med Inform 2021; 158:104663. [PMID: 34922178 DOI: 10.1016/j.ijmedinf.2021.104663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The prevalence and mortality of cardiovascular diseases are high worldwide. Telecardiology can be used to diagnose and treat these diseases. This paper aimed to review the effectiveness (positive and negative) of implemented telecardiology services in terms of clinical, economic, and patient-reported aspects. METHODS A comprehensive search was conducted in Medline (through PubMed), Scopus, ISI web of science, and IEEE Xplore databases from inception to April 7, 2021. the studies that examined the effectiveness of telecardiology interventions were included. RESULTS Fifty studies were included in this systematic review. Most investigations (22%) were conducted in the US. In 22% of studies, telecardiology intervention was used for patients with heart failure. Telecardiology has been used in most studies for tele-monitoring (n = 21, 42%) and tele-consultation (n = 17, 34%) and in 29 studies (58%), was applied for ECG transmission. The highest rate of effects reported by studies was clinical. Thirty-five studies (70%) reported the clinical effects; twenty-one studies reported the positive effects for the economic category, and fifteen studies reported the positive effect for patient-reported class. The most positive clinical effects of telecardiology were early diagnosis, early treatment, and mortality reduction. The most positive effect of the economic class was the reduction of health care costs. The most effects of the patient-reported category were improving the patient's quality of life and patient satisfaction. CONCLUSION Telecardiology can help early diagnosis and treatment of cardiovascular diseases. It also has great potential in reducing health care costs and increasing quality of life and patient satisfaction.
Collapse
Affiliation(s)
- Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorayya Rezayi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Tanhapour
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Saeedi
- Clinical Research Development Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran; Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
16
|
Mashhadi SF, Hisam A, Sikander S, Rathore MA, Rifaq F, Khan SA, Hafeez A. Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910442. [PMID: 34639741 PMCID: PMC8508113 DOI: 10.3390/ijerph181910442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.
Collapse
Affiliation(s)
- Syed Fawad Mashhadi
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan
- Correspondence:
| | - Aliya Hisam
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Siham Sikander
- Global Health Department, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mommana Ali Rathore
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Faisal Rifaq
- Sehat Sahulat Program, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, Hall 3A, 3rd Floor, Kohsar Block, Pak Secretariat, Islamabad 44000, Pakistan;
| | - Shahzad Ali Khan
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
| | - Assad Hafeez
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
| |
Collapse
|
17
|
Auener SL, Remers TEP, van Dulmen SA, Westert GP, Kool RB, Jeurissen PPT. The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review. J Med Internet Res 2021; 23:e26744. [PMID: 34586072 PMCID: PMC8515232 DOI: 10.2196/26744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Stefan L Auener
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Toine E P Remers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone A van Dulmen
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert P Westert
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rudolf B Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Patrick P T Jeurissen
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
18
|
Daley A, Scobie B, Shorey J, Breece J, Oxley S. Predicting 30-Day Readmissions: Evidence From a Small Rural Psychiatric Hospital. J Psychiatr Pract 2021; 27:346-360. [PMID: 34529601 DOI: 10.1097/pra.0000000000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals-a context that has been understudied in the literature. Our sample consisted of 1912 adult inpatients (1281 in the derivation cohort and 631 in the validation cohort), who were admitted between August 1, 2014, and July 31, 2016. We used deidentified data from the hospital's electronic medical record, including physician orders and discharge summaries. These data were merged with community-level variables that reflected the availability of care in the patients' zip codes. We first considered the correlates of 30-day readmission in a regression framework. We found that the probability of readmission increased with the number of previous admissions (vs. no readmissions). Moreover, the probability of readmission was much higher for patients with a depressive disorder (vs. no depressive disorder), with another mood disorder (vs. no other mood disorder), and/or with a psychotic disorder (vs. no psychotic disorder). We used these associations to derive a predictive model, in which we used the regression coefficients to construct a score for each patient. We then estimated the predicted probability of 30-day readmission on the basis of that score. After validating the model, we discuss the implications for clinical practice and the limitations of our approach.
Collapse
|
19
|
Matsumura ME, Austin K, Khalil Y, Blankenship JC, Martin B. Feasibility of Telephone-Based Cardiology Consultation: Comparison of Resource Use and Outcomes vs In-Person Consultation. Open Cardiovasc Med J 2021. [DOI: 10.2174/1874192402115010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The COVID-19 (Coronavirus infectious disease 2019) pandemic has highlighted the need for alternative modalities to connect with outpatients beyond in-person clinic visits. In the present study, we evaluated the feasibility of a telephone-based teleconsultation cardiology service and compared the use of testing and outcomes between teleconsultation and traditional in-office consultations
Methods:
The study took place prior to the COVID-19 pandemic July 2019 to March 2020. Consult lists were reviewed by a cardiologist for patients appropriate for teleconsultation. Those patients were contacted directly and, if agreeable, a consultation was completed and any required testing was arranged. A series of patients seen in the clinic, matched for a reason for consultation and consulting a cardiologist, were compared in terms of testing frequency and outcomes.
Results:
Of 157 patients who felt appropriate for teleconsultation, 100 (63.7%) were successfully contacted and a teleconsultation was completed. Comparing patients undergoing teleconsultation with a matched series of patients seen in person in the clinic, there were no significant differences in testing utilization or outcomes, including emergency room or hospital admission within 30 days of consultation or death or adverse cardiac events at six months following consultation.
Conclusion:
Telemedicine can be successfully utilized as an alternative to traditional clinic consultation for selected patients needing cardiology consultation. This consultative modality does not appear to lead to utilization of increased testing or decreased quality or patient outcomes. Larger studies are needed to assess this mode of consultation.
Collapse
|
20
|
Senarath S, Fernie G, Roshan Fekr A. Influential Factors in Remote Monitoring of Heart Failure Patients: A Review of the Literature and Direction for Future Research. SENSORS 2021; 21:s21113575. [PMID: 34063825 PMCID: PMC8196679 DOI: 10.3390/s21113575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
With new advances in technology, remote monitoring of heart failure (HF) patients has become increasingly prevalent and has the potential to greatly enhance the outcome of care. Many studies have focused on implementing systems for the management of HF by analyzing physiological signals for the early detection of HF decompensation. This paper reviews recent literature exploring significant physiological variables, compares their reliability in predicting HF-related events, and examines the findings according to the monitored variables used such as body weight, bio-impedance, blood pressure, heart rate, and respiration rate. The reviewed studies identified correlations between the monitored variables and the number of alarms, HF-related events, and/or readmission rates. It was observed that the most promising results came from studies that used a combination of multiple parameters, compared to using an individual variable. The main challenges discussed include inaccurate data collection leading to contradictory outcomes from different studies, compliance with daily monitoring, and consideration of additional factors such as physical activity and diet. The findings demonstrate the need for a shared remote monitoring platform which can lead to a significant reduction of false alarms and help in collecting reliable data from the patients for clinical use especially for the prevention of cardiac events.
Collapse
Affiliation(s)
- Sashini Senarath
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
- Correspondence:
| | - Geoff Fernie
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
| | - Atena Roshan Fekr
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
| |
Collapse
|
21
|
Kitsiou S, Vatani H, Paré G, Gerber BS, Buchholz SW, Kansal MM, Leigh J, Masterson Creber RM. Effectiveness of Mobile Health Technology Interventions for Patients With Heart Failure: Systematic Review and Meta-analysis. Can J Cardiol 2021; 37:1248-1259. [PMID: 33667616 DOI: 10.1016/j.cjca.2021.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a complex and serious condition associated with substantial morbidity, mortality, and health care costs. We conducted a systematic review and meta-analysis to evaluate the effects of mobile health (mHealth) interventions compared with usual care in patients with HF. METHODS We searched MEDLINE, CENTRAL, CINAHL, and EMBASE databases to identify eligible randomized controlled trials (RCTs) of mHealth interventions. Primary outcomes included: all-cause mortality, cardiovascular mortality, HF-related hospitalizations, and all-cause hospitalizations. Meta-analyses using a random effects model were performed for all outcomes. Risk of bias and quality of evidence were evaluated using the Cochrane Tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Sixteen RCTs involving 4389 patients were included. Compared with usual care, mHealth interventions reduced the risk of all-cause mortality (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.65-0.97; absolute risk reduction [ARR], 2.1%; high-quality evidence), cardiovascular mortality (RR, 0.70; 95% CI, 0.53-0.91; ARR, 2.9%; high-quality evidence), and HF hospitalizations (RR, 0.77; 95% CI, 0.67-0.88; ARR, 5%; high-quality evidence), but had no effect on all-cause hospitalizations. Results were driven by mHealth interventions with remote monitoring and clinical feedback, which were associated with larger reductions than stand-alone mHealth interventions. However, subgroup differences were not statistically significant. CONCLUSIONS mHealth interventions with remote monitoring and clinical feedback reduce mortality and HF-related hospitalizations, but might not reduce all-cause hospitalizations in patients with HF. Additional studies are needed to determine the efficacy of stand-alone mHealth interventions as well as active features of mHealth that contribute to efficacy.
Collapse
Affiliation(s)
- Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Haleh Vatani
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Guy Paré
- Research Chair in Diginal Health, HEC Montréal, Montréal, Quebec, Canada
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Susan W Buchholz
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Mayank M Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jonathan Leigh
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA; Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ruth M Masterson Creber
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
22
|
Rabbe S, Blankart CR, Franz WM, Hager L, Schreyögg J. Impact of a telemonitoring intervention in patients with chronic heart failure in Germany: A difference-in-difference matching approach using real-world data. J Telemed Telecare 2021; 29:365-373. [PMID: 33557666 DOI: 10.1177/1357633x20984024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effects of a non-invasive telemonitoring intervention on mortality, healthcare costs, and hospital and pharmaceutical utilisation in patients with chronic heart failure (CHF) of a large statutory health insurer in Germany. METHODS In a retrospective observational cohort study using real-world data, we assessed differences between 635 patients who received a telemonitoring intervention versus 635 receiving usual care covering 36 months after intervention. We used propensity score matching on a set of 102 parameters collected in the 24-month pre-intervention period to correct for observed differences, as well as difference-in-difference (DiD) estimators to account for unobserved differences. We analysed the effect of the intervention for up to three years on (i) all-cause mortality; (ii) costs (i.e. inpatient stays, ambulatory care, pharmaceuticals, and medical aids and appliances); and (iii) healthcare utilisation (i.e. length and number of hospital stays, number of prescriptions). RESULTS DiD estimates suggest lower inpatient costs of the telemonitoring group of up to €1160 (95% confidence interval (CI): -2253 to -69) in year three. Ambulatory care costs increased significantly in all three years up to €316 (95% CI: 1267 to 505) per year. Telemonitoring had a positive effect on survival (hazard ratio = 0.71; 95% CI: 0.51 to 0.99) and increased the number of prescriptions for diuretics. Effects were more prominent for patients with severe CHF. DISCUSSION The study suggests that the telemonitoring intervention led to a significant decrease in mortality and a shift in costs from the inpatient to the ambulatory care sector 36 months after intervention.
Collapse
Affiliation(s)
- Stefan Rabbe
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Carl R Blankart
- KPM Center for Public Management, University of Bern, Bern, Switzerland.,Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | | | | | - Jonas Schreyögg
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| |
Collapse
|
23
|
Ma X, Li J, Ren X. The efficacy of telemedical care for heart failure: A meta-analysis of randomized controlled trials. Am J Emerg Med 2021; 47:1-5. [PMID: 33744485 DOI: 10.1016/j.ajem.2021.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The efficacy of telemedical care for the treatment of heart failure remains controversial. We conduct a systematic review and meta-analysis to explore the impact of telemedical care on heart failure. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2020 for randomized controlled trials (RCTs) assessing the effect of telemedical care on heart failure. This meta-analysis is performed using the random-effect model. RESULTS Four RCTs involving 2516 patients are included in the meta-analysis. Overall, compared with control group for heart failure, telemedical care demonstrates no significant influence on cardiovascular death (OR = 0.74; 95% CI = 0.54 to 1.00; P = 0.05), mortality (OR = 0.86; 95% CI = 0.61 to 1.20; P = 0.38), hospital stay for heart failure (SMD = -1.57; 95% CI = -6.31 to 3.16; P = 0.52) or hospital stay for any readmission (SMD = -0.65; 95% CI = -8.98 to 7.68; P = 0.88), but can reduce the days lost due to death or heart failure readmissions (SMD = -6.50; 95% CI = -8.44 to -4.56; P < 0.00001). CONCLUSIONS Telemedical care may provide no additional benefits for heart failure.
Collapse
Affiliation(s)
- XuHui Ma
- Department of Critical Care Medicine, Fenghua District People's Hospital of Ningbo, Zhejiang, China
| | - Jie Li
- Department of Critical Care Medicine, Fenghua District People's Hospital of Ningbo, Zhejiang, China
| | - XiuZan Ren
- Department of Critical Care Medicine, Fenghua District People's Hospital of Ningbo, Zhejiang, China.
| |
Collapse
|
24
|
Piotrowicz E, Pencina MJ, Opolski G, Zareba W, Banach M, Kowalik I, Orzechowski P, Szalewska D, Pluta S, Glówczynska R, Irzmanski R, Oreziak A, Kalarus Z, Lewicka E, Cacko A, Mierzynska A, Piotrowicz R. Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial. JAMA Cardiol 2021; 5:300-308. [PMID: 31734701 DOI: 10.1001/jamacardio.2019.5006] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Guidelines recommend exercise training as a component of heart failure management. There are large disparities in access to rehabilitation, and introducing hybrid comprehensive telerehabilitation (HCTR) consisting of remote monitoring of training at patients' homes might be an appealing alternative. Objective To assess whether potential improvements in quality-of-life outcomes after a 9-week HCTR intervention in patients with heart failure translate into improvement in clinical outcomes during extended 12 to 24 months of follow-up, compared with usual care. Design, Setting, and Participants The Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial is a multicenter, prospective, open-label, parallel-group randomized clinical trial that enrolled 850 patients with heart failure up to 6 months after a cardiovascular hospitalization with New York Heart Association levels I, II, or III and left ventricular ejection fraction of 40% or less. Patients from 5 centers in Poland were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months after randomization. Interventions During the first 9 weeks, patients underwent either an HCTR program (1 week in hospital and 8 weeks at home) or usual care with observation. The HCTR intervention encompassed telecare, telerehabilitation, and remote monitoring of implantable devices. No intervention occurred in the remaining study period. Main Outcomes and Measures The percentage of days alive and out of the hospital from randomization through the end of follow-up at 14 to 26 months. Results A total of 850 patients were enrolled, with 425 randomized to the HCTR group (377 male patients [88.7%]; mean [SD] age, 62.6 [10.8] years) and 425 randomized to usual care (376 male patients [88.5%]; mean [SD] age, 62.2 [10.2] years). The HCTR intervention did not extend the percentage of days alive and out of the hospital. The mean (SD) days were 91.9 (19.3) days in the HCTR group vs 92.8 (18.3) days in the usual-care group, with the probability that HCTR extends days alive and out of the hospital equal to 0.49 (95% CI, 0.46-0.53; P = .74) vs usual care. During follow-up, 54 patients died in the HCTR arm and 52 in the usual-care arm, with mortality rates at 26 months of 12.5% vs 12.4%, respectively (hazard ratio, 1.03 [95% CI, 0.70-1.51]). There were also no differences in hospitalization rates (hazard ratio, 0.94 [95% CI, 0.79-1.13]). The HCTR intervention was effective at 9 weeks, significantly improving peak oxygen consumption (0.95 [95% CI, 0.65-1.26] mL/kg/min vs 0.00 [95% CI, -0.31 to 0.30] mL/kg/min; P < .001) and quality of life (Medical Outcome Survey Short Form-36 questionnaire score, 1.58 [95% CI, 0.74-2.42] vs 0.00 [95% CI, -0.84 to 0.84]; P = .008), and it was well tolerated, with no serious adverse events during exercise. Conclusions and Relevance In this trial, the positive effects of a 9-week program of HCTR in patients with heart failure did not lead to the increase in percentage of days alive and out of the hospital and did not reduce mortality and hospitalization over a follow-up period of 14 to 26 months. Trial Registration ClinicalTrials.gov identifier: NCT02523560.
Collapse
Affiliation(s)
- Ewa Piotrowicz
- Telecardiology Center, Institute of Cardiology, Warsaw, Poland
| | - Michael J Pencina
- Duke University School of Medicine, Durham, North Carolina.,Deputy Editor for Statistics, JAMA Cardiology
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, Łódź, Poland
| | | | | | - Dominika Szalewska
- Department of Rehabilitation Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Slawomir Pluta
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, Zabrze, Poland
| | | | - Robert Irzmanski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, Łódź, Poland
| | - Artur Oreziak
- Department of Arrhythmia, Institute of Cardiology, Warsaw, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, Zabrze, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Cacko
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna Mierzynska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
25
|
Nan J, Jia R, Meng S, Jin Y, Chen W, Hu H. The Impact of the COVID-19 Pandemic and the Importance of Telemedicine in Managing Acute ST Segment Elevation Myocardial Infarction Patients: Preliminary Experience and Literature Review. J Med Syst 2021; 45:9. [PMID: 33404890 PMCID: PMC7785918 DOI: 10.1007/s10916-020-01703-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19), which is caused by a novel coronavirus (SARS-COV-2), has compromised health care systems and normal management of patients with cardiovascular diseases [1-3]. Patients with non-communicable diseases, including acute myocardial infarction (AMI) are vulnerable to this stress [4, 5]. Acute ST segment elevation myocardial infarction (STEMI), the most critical type of AMI, is associated with high mortality even with modern medicine [6-8]. Timely reperfusion therapy is critical for STEMI patients because a short ischemia time is associated with better clinical outcomes and lower acute and long -term mortality [9-12]. The COVID-19 pandemic placed the management of STEMI patients in a difficult situation due to the need to balance timely reperfusion therapy and maintaining strict infection control practices [13, 14]. Telemedicine, which is used to deliver health care services using information or communication technology, provides an opportunity to carry out the evaluation, diagnosis, and even monitor the patients after discharge when social distancing is needed [15]. In this article, we reported our preliminary experience with the usefulness of telemedicine in managing STEMI patients during the COVID-19 pandemic. We also provided a review of this topic.
Collapse
Affiliation(s)
- Jing Nan
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ruofei Jia
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Shuai Meng
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Yubo Jin
- Phillips Academy Andover, Andover, MA, USA
| | - Wei Chen
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| | - Hongyu Hu
- Department of cardiology and macrovascular disease, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| |
Collapse
|
26
|
Guilleux M. [Cardiac failure and remote monitoring: a new management approach?]. REVUE DE L'INFIRMIÈRE 2020; 69:46-47. [PMID: 32532445 DOI: 10.1016/j.revinf.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Heart failure is the leading cause of hospitalization of people aged 60-65 in France, with a rising rate of rehospitalization. This explains the very high healthcare costs in all Western countries and in the United States. Remote monitoring is one of the avenues being studied to reduce this rate of rehospitalisation: it is becoming a reality and should bring about changes in the nursing profession in the years to come.
Collapse
Affiliation(s)
- Marion Guilleux
- Serenity Medical Services - Institut du cerveau et de la moelle épinière - Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, CS 21414, 75013 Paris, France.
| |
Collapse
|
27
|
Iellamo F, Sposato B, Volterrani M. Telemonitoring for the Management of Patients with Heart Failure. Card Fail Rev 2020; 6:e07. [PMID: 32377386 PMCID: PMC7199126 DOI: 10.15420/cfr.2019.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/23/2020] [Indexed: 11/04/2022] Open
Abstract
Advances in technology now make it possible to manage heart failure (HF) from a remote to a telemonitoring approach using either noninvasive solutions or implantable devices. Nowadays, it is possible to monitor at-home parameters that can be recorded, stored and remotely transmitted to physicians, allowing them to make decisions for therapeutic modification, hospitalization or access to the emergency room. Standalone systems are available that are equipped with self-intelligence and are able to acquire and elaborate data that can inform the remote physician of impending decompensation before it results in additional complications. The development of miniature implantable devices, which could measure haemodynamic variables and transmit them to a monitor outside the body, offers the possibility for the physician to obtain more frequent evaluations of HF patients and the opportunity to take these data into account in management decisions. At present, several telemonitoring devices are available, but the only Food and Drug Administration-approved system is the cardio-microelectromechanical system, which is an implantable pulmonary arterial pressure (PAP) monitoring device that allows a direct monitoring of the PAP via a sensor implanted in the pulmonary artery. This information is then uploaded to a web-based interface from which healthcare providers can track the results and manage patients. At present, the challenge point for telemedicine management of HF is to find the more relevant biological parameter to monitor the clinical status.
Collapse
Affiliation(s)
- Ferdinando Iellamo
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Italy.,Department of Clinical Science and Translational Medicine, University Tor Vergata Rome, Italy
| | - Barbara Sposato
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Italy
| | - Maurizio Volterrani
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Italy
| |
Collapse
|
28
|
Vestergaard AS, Hansen L, Sørensen SS, Jensen MB, Ehlers LH. Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial. BMJ Open 2020; 10:e031670. [PMID: 31992604 PMCID: PMC7045102 DOI: 10.1136/bmjopen-2019-031670] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/20/2019] [Accepted: 01/02/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to assess the cost-effectiveness of telehealthcare in heart failure patients as add-on to usual care. DESIGN A cost-utility analysis was conducted from a public payer perspective alongside the randomised controlled TeleCare North trial. SETTING The North Denmark Region, Denmark. PARTICIPANTS The study included 274 heart failure patients with self-reported New York Heart Association class II-IV. INTERVENTIONS Patients in the intervention group were provided with a Telekit consisting of a tablet, a digital blood pressure monitor, and a scale and were instructed to perform measurements one to two times a week. The responsibility of the education, instructions and monitoring of the heart failure (HF) patients was placed on municipality nurses trained in HF and telemonitoring. Both groups received usual care. OUTCOME MEASURES Cost-effectiveness was reported as incremental net monetary benefit (NMB). A micro-costing approach was applied to evaluate the derived savings in the first year in the public health sector. Quality-adjusted life-years (QALY) gained were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at baseline and at a 1-year follow-up. RESULTS Data for 274 patients were included in the main analysis. The telehealthcare solution provided a positive incremental NMB of £5164. The 1-year adjusted QALY difference between the telehealthcare solution and the usual care group was 0.0034 (95% CI: -0.0711 to 0.0780). The adjusted difference in costs was -£5096 (95% CI: -8736 to -1456) corresponding to a reduction in total healthcare costs by 35%. All sensitivity analyses showed the main results were robust. CONCLUSIONS The TeleCare North solution for monitoring HF was highly cost-effective. There were significant cost savings on hospitalisations, primary care contacts and total costs. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02860013.
Collapse
Affiliation(s)
- Anne Sig Vestergaard
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| | - Louise Hansen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| | - Sabrina Storgaard Sørensen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| | | | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| |
Collapse
|
29
|
Koehler F, Koehler K, Prescher S, Kirwan BA, Wegscheider K, Vettorazzi E, Lezius S, Winkler S, Moeller V, Fiss G, Schleder J, Koehler M, Zugck C, Störk S, Butter C, Prondzinsky R, Spethmann S, Angermann C, Stangl V, Halle M, von Haehling S, Dreger H, Stangl K, Deckwart O, Anker SD. Mortality and morbidity 1 year after stopping a remote patient management intervention: extended follow-up results from the telemedical interventional management in patients with heart failure II (TIM-HF2) randomised trial. LANCET DIGITAL HEALTH 2020; 2:e16-e24. [DOI: 10.1016/s2589-7500(19)30195-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 01/08/2023]
|