Post-discharge telemonitoring fails to improve HF outcomes
MedWire News: Telemonitoring does not appear to improve clinical outcomes for recently hospitalized heart failure (HF) patients, a large trial has found.
Despite promising pilot studies, the telephone call-in system did not impact on the likelihood of hospital readmission or other HF-related endpoints when compared with usual care.
"The results indicate the importance of a thorough, independent evaluation of disease-management strategies before their adoption," warn Harlan Krumholz (Yale University School of Medicine, New Haven, Connecticut) and fellow investigators writing in the New England Journal of Medicine.
Krumholz's team developed a telephone-based interactive voice-response system that collected daily information about symptoms and weight. The information was relayed to the patients' clinicians on a daily basis, with the idea of facilitating earlier intervention in the event of deterioration.
The system was tested in a multicenter trial involving 1653 patients who had been hospitalized for HF in the previous 30 days. They were randomly assigned to telemonitoring or to usual care; all patients were instructed to contact their HF clinician directly with any urgent concerns.
In all, 85.6% of the telemonitoring group made at least one telephone call to their clinician during the 6-month study period. Use of the system was greatest (90.2%) in the first week of the study period and declined to just 55.1% by week 26.
The study's primary endpoint, a composite of death or readmission for HF, did not differ between the telemonitoring and control groups (52.3% vs 51.5%, hazard ratio=1.04).
Nor did any of the secondary endpoints, which included death (11.1% vs 11.4%), readmission (49.3% vs 47.4%), HF readmission (27.5% vs 27.0%), mean number of days in hospital (7.2 vs 7.0), or number of readmissions.
In subgroup analyses, none of the baseline patient or center characteristics identified a group in which telemonitoring was effective. However, no adverse events were reported.
Discussing the reason for their negative result, Krumholz et al suggest that "communication alone is not enough" and other system-wide changes may also be necessary to improve patient outcomes.
"Flaws in our health care system - in the mechanics of delivering care - are responsible for many adverse outcomes for patients," Krumholz remarked.
"It is not just how ill patients are, but how well the system functions for them and supports them in managing their recovery."
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By Joanna Lyford