Current Heart Failure Reports

, Volume 9, Issue 1, pp 75–80

Clinical Use of Telemonitoring in Chronic Heart Failure: Keeping up with the Times or Misuse of Time?

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)

Abstract

Close follow-up of patients with severe heart failure, especially after hospital discharge, has been shown to impact the mortality and readmission rates in this patient population. Monitoring of the patients’ physiological status is important for predicting a potential heart failure decompensation. Earlier studies on structured telephone support and telemonitoring suggested a clear benefit on mortality and heart failure admissions, though recent large randomized controlled trials have been neutral. This review looks into the possible reasons for discrepancies in the outcomes. Remote monitoring of implantable cardiac devices is becoming increasingly utilized in a proportion of patients for device follow-up, and recent technology advances have suggested utility of certain device algorithms in detecting heart failure decompensations. Implantable hemodynamic monitors also show promise in this sphere, though have limited evidence at this stage, and further development in the technology is likely before they become part of routine practice.

Keywords

Heart failure Hospitalization Remote monitoring Telemonitoring Implantable defibrillator Cardiac resynchronization therapy Impedance Pressure monitor Nonpharmacologic therapy 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Fonarow GC, Stevenson LW, Walden JA, et al. Impact of comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol. 1997;30(3):725.PubMedCrossRefGoogle Scholar
  2. 2.
    Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the diagnosis and management of heart failure in adults. Circulation. 2009;119:e391.PubMedCrossRefGoogle Scholar
  3. 3.
    Solomon SD, Dobson J, Pocock S, et al. Candesartan in Heart Failure: Assessment of reduction in mortality and morbidity (CHARM) investigators. Circulation. 2007;116(13):1482.PubMedCrossRefGoogle Scholar
  4. 4.
    GESICA Investigators. Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ. 2005;331:425.CrossRefGoogle Scholar
  5. 5.
    Clark RA, Inglis SC, McAlister FA, et al. Tele- monitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007;334:942.PubMedCrossRefGoogle Scholar
  6. 6.
    • Inglis SC, Clark RA, McAlister FA, et al.: Structured telephone support or telemonitoring programmes for patients with chronic heart failure (Review). Cochrane Collaboration, The Cochrane Library 2010, Issue 8. This is a recent large meta-analysis of telephone support and telemonitoring in heart failure. Google Scholar
  7. 7.
    • Klersy C, De Silvestri A, Gabutti G, et al.: A meta-analysis of remote monitoring of heart failure patients. J. Am. Coll. Cardiol. 2009;54;1683–1694. This is a meta-analysis of randomized controlled trials and cohort studies in remote monitoring including telemonitoring, telephone support, devices in monitoring, and implantable hemodynamic monitors. Overall, this meta-analysis showed both telephone support and technology-assisted monitoring had hospitalization and mortality benefits. PubMedCrossRefGoogle Scholar
  8. 8.
    Goldberg LR, Piette JD, Walsh MN, et al. A daily electronic home monitoring system in patients with advanced heart failure improves survival: the WHARF (weight monitoring in heart failure) trial. J Card Fail. 2002;8:S54.Google Scholar
  9. 9.
    Cleland JG, Louis AA, Rigby AS, et al. Noninvasive home monitoring for patients with heart failure at high risk of recurren admission and death: The Ten – HMS Study. Heart Failure. 2005;45:10.Google Scholar
  10. 10.
    •• Koehler F, Winkler S, Schiever M, et al.: Telemedical Intervnetional Monitoring in Heart Failure (TIM-HF), a randomizd, controlled inervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. European Journal of Heart Failure (2010) 12, 1354–1362. This randomized controlled trial showed no benefit of telemonitoring (of parameters, namely weight, blood pressure, and ECG) over usual care in patients with severe LV failure on optimal medical therapy. Overall mortality in both groups was lower than similar studies. CrossRefGoogle Scholar
  11. 11.
    •• Chaudhry SI, Mattera JA, Curtis JP, et al.: Telemonitoring in Patients with Heart Failure. N Engl J Med 2010;363:2301–9. This well-designed randomized controlled trial compared a form of telemonitoring to usual care. Patients were asked to use a commercial telephone voice-response system that assessed their heart failure symptoms daily. Although the study showed no benefit on mortality or hospitalization, patient adherence to the telemonitoring system was low. PubMedCrossRefGoogle Scholar
  12. 12.
    HRS/EHRA Expert consensus on the monitoring of cardiovascular implantable electronic devices. Description of techniques, indications, personnel, frequency and ethical considerations. Europace. 2008;10:707–25.CrossRefGoogle Scholar
  13. 13.
    Crossley GH, Boyle A, Vitense H, et al. The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial: The value of wireless remote monitoring with automatic clinician alerts. JACC. 2011;57:1181–9.PubMedGoogle Scholar
  14. 14.
    Dries DL, Exner DV, Gersch BJ. Atrial fibrillation is associated with increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular dysfunction. J Am Coll Cardiol. 1998;S32:695–703.CrossRefGoogle Scholar
  15. 15.
    Madsen BK, Hansen JF, Stokholm KH, et al. Chronic congestive cardiac failure. Description and survival of 190 consecutive patients with a diagnosis of chronic congestive cardiac failure based on clinical signs and symptoms. Eur Heart J. 1994;15:304–6.Google Scholar
  16. 16.
    Ellery S, Pakrashi T, Paul V, Sack S. Predicting mortality and rehospitalisation in heart failure patients with home monitoring–the Home CARE pilot study. Clin Res Cardiol. 2006;95 Suppl 3:III29–35.PubMedCrossRefGoogle Scholar
  17. 17.
    La Rovere MT, Pinna GD, Maestri R, et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003;107:565–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Adamson PB, Smith AL, Abraham WT, et al.: Continuous Autonomic Assessment in Patients With Symptomatic Heart Failure: Prognostic Value of Heart Rate Variability Measured by an Implanted Cardiac Resynchronization Device Circulation 2004; 110:2389–2394.Google Scholar
  19. 19.
    Ewald GA, Gilliam FR, Sweeney RJ. Automated HF Decompensation Detection: Results from the Decompensation Detection Study (DECODE). J Card Fail. 2009;15:S122.CrossRefGoogle Scholar
  20. 20.
    Abraham WT. Intrathoracic impedance monitoring for early detection of heart failure decompensation. CHF. 2007;13:113–5.PubMedGoogle Scholar
  21. 21.
    Yu CM, Wang L, Chau E, et al.: Intrathoracic Impedance Monitoring in Patients With Heart Failure: Correlation With Fluid Status and Feasibility of Early Warning Preceding Hospitalization Circulation 2005;112:841–848Google Scholar
  22. 22.
    Abraham WT, Compton S, Haas G, et al.: Superior performance of intrathoracic impedence-derived fluid index versus daily weight monitoring in heart failure patients: Results of the fluid accumulation status trial (FAST). J Cardiac Fail 2009; 15: 9,813Google Scholar
  23. 23.
    Ypenburg C, Bax JJ, Van Der Wall EE, et al. In- trathoracic impedance monitoring to predict decompensated heart failure. Am J Cardiol. 2007;99:554–7.PubMedCrossRefGoogle Scholar
  24. 24.
    • Catanzariti D, Lunati M, Landolina M, et al.: Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure. PACE 2009; 32:363–370. In this large prospective trial, 532 patients with heart failure were followed-up after insertion of a defibrillator. The results showed a reduction in hospitalizations with the use of intrathoracic impedance monitoring (OptiVol). A proportion of patients (102) had the audible alarm for OptiVol turned off, and these patients had higher HF hospitalization rates (20%) than the patients with the alarm turned on (7%) after 11-month follow-up. PubMedCrossRefGoogle Scholar
  25. 25.
    Whellan D, Ousdigian KT, Al-Khatib SM, et al. Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalization. J Am Coll Cardiol. 2010;55:1803–10.PubMedCrossRefGoogle Scholar
  26. 26.
  27. 27.
  28. 28.
    Brachmann J, Bohm M, Rybak K, et al. Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLin HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink). Eur J Hear Fail. 2011;13:796–804.CrossRefGoogle Scholar
  29. 29.
    Bourge RC, Abraham WT, Adamson PB, et al. Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: The COMPASS-HF Study. J Am Coll Cardiol. 2008;51:1073–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Abraham WT, Adamson PB; CHAMPION Trial Committees and Study Group: Primary Results of the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) Trial [abstract]. European Society of Cardiology Heart Failure Congress 2010, Berlin, Germany.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Royal Perth HospitalPerthAustralia

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