Telehealth presents numerous benefits to patients living with heart failure. As technology develops, an increasing number of clinicians will utilize telehealth to improve patient outcomes and reduce hospital admissions. A recent randomized control trial took a deep dive into the efficacy of telehealth with the heart failure patient population. The study concluded that remote monitoring interventions can reduce length of hospital stay and decrease mortality related to heart failure.
A Randomized Controlled Trial on Heart Failure and Telehealth
Heart failure is a chronic disorder that leaves patients prone to exacerbations and hospital readmissions. Clinicians are constantly challenged to find ways to reduce hospitalizations for worsening heart failure. Remote patient management for patients with heart failure can facilitate early detection of signs and symptoms of cardiac decompensation, allowing care providers to quickly respond to their patients' needs and subsequently reduce the likelihood of hospitalization.
A 2018 randomized controlled trial aimed to evaluate the efficacy of remote patient management on mortality and morbidity in the heart failure patient population. The study compared patients who received telemonitoring plus usual care to patients who received only usual care. The primary outcome of the trial was days lost due to unplanned cardiovascular hospital admissions or all-cause death. The secondary outcomes were all cause mortality and cardiovascular mortality.
The researchers chose to evaluate the percentage of days lost due to hospital admissions as the primary outcome in order to demonstrate the influence of remote patient monitoring on the length of hospital stay. The duration of a patient’s time in the hospital has significant implications for both the patient and the payor. As a result, the findings of this study directly demonstrate the influence of telehealth on healthcare efficiency and patient outcomes.
Usual Care vs. Telehealth for Heart Failure
The patients included in the study were followed up for at least 365 days. All study participants had heart failure and were in New York Heart Association class II or III. Additionally, all study participants been admitted to the hospital for heart failure within 12 months of randomization and had a left ventricular ejection fraction (EF) of 45% or lower (if the EF was greater than 45%, the patient must have been treated with oral diuretics to be included). Patients with major depression were not included in the study.
Patients participating in the remote monitoring intervention were provided with a tablet that connected to an electrocardiogram, a blood pressure monitoring device, and weight scales. The following data was electronically transmitted to the telemedical center on a daily basis:
Analysis of heart rhythm
Peripheral capillary oxygen saturation (SpO2)
Self-rated health status change (on a scale from 1-5)
The remote monitoring intervention also included patient education and direct communication between the telemedical center and each patient’s cardiologist. Additionally, a certified nurse conducted telephone interviews with patients on a monthly basis.
The telemedical center regularly evaluated the patient’s physiological data, in addition to their medications. The telephone interviews were an opportunity to evaluate a patient’s symptoms and to address technical issues that came up with the equipment.
Patients in the usual care group were followed up according to the current protocol for the management of patients with heart failure. Both groups of patients were seen by a cardiologist at time of screening, for a baseline visit, and for a final visit. Additionally, patients were seen by their general practitioner (GP) or local cardiologist at 3, 5, and 9 months follow up. This allowed the GPs or cardiologist to adjust treatments as necessary throughout the study period.
Improving Patient Outcomes with Telehealth
The authors found that the percentage of days lost due to cardiovascular hospital admissions or all-cause death was significantly reduced in patients in the remote patient management group compared to the usual care group. Specifically, the researchers found the following results related to days lost:
The percentage of days lost due to unplanned cardiovascular hospital admissions and all cause death was 4.88% in the remote patient management group and 6.64% in the usual care group.
Patients in the remote patient management group lost a mean of 17.8 days per year, while patients in the usual care group lost 24.2 days per year.
When looking at days lost due to worsening heart failure specifically, patients in the remote patient management group lost a mean of 3.5 days per year, while patients in the usual care group lost a mean of 5.6 days per year.
While cardiovascular mortality did not show a statistical difference between groups, the all cause death rate was significantly different between the remote patient management group and the usual care group:
The all cause death rate was 7.9% per 100 person years of follow-up in the remote patient management group and 11.34% per 100 person years of follow-up in the usual care group.
Another interesting result in the study pertained to the geographical location of the patients. The authors noted that the results of this study did not differ among patients in rural or metropolitan areas. This was a positive finding that demonstrates the potential of telehealth to equalize healthcare access, regardless of where a patient resides.
The Future of Heart Failure Management
The authors attribute much of the success of the telemonitoring trial to the ability of the clinicians to adjust patient care as needed. Because physiological data was transmitted to the clinicians on a daily basis, the care providers were able to individualize care and respond quickly to the patients’ changing medical needs. This type of continuous care was not possible with the patients in the usual care group.
The results of this study demonstrate that telemonitoring is a valuable, and perhaps necessary, component of the care plan for patients with heart failure. As the demand for superior patient outcomes grows, more healthcare providers will find their way toward telemonitoring. With this trend toward digital health, we are sure to see more effective use of resources, enhanced healthcare efficiency, and most importantly, improved patient outcomes.
Koehler F, Koehler K, Deckwart O, Prescher S, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomized, controlled, parallel-group, unmasked trial. Lancet. 2018 Sep 22;392(10152):1047-1057.