11.2 The Appropriate Drugs Titration and the Optimization of the Therapy in Chronic Heart Failure (CHF): the Outcomes in our Experience of Home TelemonItoring (HTM)
Introduction. The primary end-points of the treatment of CHF are the reduction of mortality, morbidity and hospitalization and the improvement of the quality of life of the patient. However, many clinical trials showed an underuse of the drugs recommended by the Guidelines, with a displacement in favour of diuretics, nitrates and digoxin and an inferior prescription of beta-blockers, antialdosterone drugs, ACE-inhibitors (ACEI) and angiotensin II receptor blockers (ARBs). We sought if home telemonitoring was able to optimize the therapy of patients with CHF and to improve their compliance and quality of life.
Methods. We enrolled 38 patients aged between 55 and 90 years (mean 73.7 ys, 25 males, 13 females) with a recent admission for CHF and LVEF < 40% or diastolic dysfunction. The patients sent data via the Internet (ECG, blood pressure, heart rate, diuresis, weight), underwent a brief interview and received back instructions for the adjustment of the therapy and the way of life, with a weekly contact for 6 months after discharge. Quality of life was measured by means of Minnesota Living with Heart Failure Questionnaire (MLHFQ).
Results. At the enrolment, the rates of the utilized drugs were as follows: beta-blockers 40%, ACEI or ARBs 69%, antialdosterone drugs 10%, diuretics 86%, digoxin 60%. At the end of the period of home telemonitoring, the rates of use were: beta-blockers 98%, ACEI or ARBs 100%, antialdosterone drugs 90%, diuretics 100%, digoxin 15%. At the beginning, the mean LVEF was 29.3%, while after 6 months was 37.9% (p<0.001). Considering the patients that at the beginning were in III NYHA class, after 6 months 4 were in II (17%), 2 in II–III (8%) and 18 remained in III (75%); considering the patients that at the beginning were in IV NYHA class, 1 shifted into II (7%), 6 into II–III (43%) and 7 into III (50%). The rate of mortality at 6 months was 5% and that of re-hospitalization was 26%. The MLHFQ at the beginning was 54.8 (30–76, range 46), after 6 months improved to 21.3 (5–70, range 65) (p<0.001).
Conclusions. Our study in terms of mortality, re-hospitalization and quality of life shows that the progressive drugs titration and the optimization of the therapy in CHF, as recommended by the Guidelines, is safe, appropriate and effective in improving the outcomes of these patients in the first months after discharge. In particular, home telemonitoring is an extraordinary support especially for the proper titration of beta-blockers, ACEI and ARBs, still often underused in these patients.
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Beltrami, L., Benvenuto, M., Redaelli, C. et al. 11.2 The Appropriate Drugs Titration and the Optimization of the Therapy in Chronic Heart Failure (CHF): the Outcomes in our Experience of Home TelemonItoring (HTM). High Blood Press Cardiovasc Prev 15, 298 (2008). https://doi.org/10.1007/BF03263710