A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases

BRIEF SUMMARY

The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective.

BACKGROUND

Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF).

OBJECTIVE

To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF.

DESIGN

Randomized phase 3 multicenter clinical trial with parallel groups in adult patients.

PARTICIPANTS

Five spanish centers including patients with AHLF at discharge or in out-patient clinics.

INTERVENTION

Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response.

MAIN MEASURES

Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy.

RESULTS

510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros).

CONCLUSIONS

The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

Through-ring bonding in edge sharing dimers of octahedral complexes

A study of the preferred structures for the M2X2 rings in the binuclear complexes of types [M2(mu-XR2)2L8] and [M2(mu-XR3)2L8] is presented, based on qualitative orbital arguments supported by extended Hückel calculations on Cr compounds. The main conclusions are confirmed by DFT calculations on key compounds of Cr and Mn and agree well with the results of a structural database analysis. With the simplified electron counting scheme deduced, complexes with six or four electrons available for bonding of the M2X2 framework are predicted to have two possible minimum energy structures, with either a short M-M or X-X distance, whereas compounds with eight framework electrons are expected to present no short through-ring distance. Such a behavior is consistent with the framework electron rules reported earlier for compounds with different coordination spheres and provides a general description of the structure and bonding in a variety of compounds with M2X2 diamonds. Metal-metal bonding across the ring can be equally predicted taking into account only the bonding characteristics of the t2g-like orbitals for the XR2- but not for the XR3-bridged complexes. In addition, the framework electron counting scheme has the advantage of being independent of the formal oxidation state assigned to the metal atom.