Tailored telemonitoring in patients with heart failure

Results of a multicentre randomized controlled trial

J.J. Boyne, H.J.M. Vrijhoef, H.J.G.M. Crijns, G. de Weerd, J. Kragten, A.P.M. Gorgels

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Aims Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. Methods and results A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32–93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan–Meier P = 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35–1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan–Meier P = 0.641, HR 0.89, 95% CI 0.69–1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann–Whitney P < 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann–Whitney P = 0.34, Cox regression analysis P = 0.82). Conclusion No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed.
Original languageEnglish
Pages (from-to)791-801
JournalEuropean Journal of Heart Failure
Volume14
Issue number7
DOIs
Publication statusPublished - 2012

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Boyne, J. J., Vrijhoef, H. J. M., Crijns, H. J. G. M., de Weerd, G., Kragten, J., & Gorgels, A. P. M. (2012). Tailored telemonitoring in patients with heart failure: Results of a multicentre randomized controlled trial. European Journal of Heart Failure, 14(7), 791-801. https://doi.org/10.1093/eurjhf/hfs058
Boyne, J.J. ; Vrijhoef, H.J.M. ; Crijns, H.J.G.M. ; de Weerd, G. ; Kragten, J. ; Gorgels, A.P.M. / Tailored telemonitoring in patients with heart failure : Results of a multicentre randomized controlled trial. In: European Journal of Heart Failure. 2012 ; Vol. 14, No. 7. pp. 791-801.
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title = "Tailored telemonitoring in patients with heart failure: Results of a multicentre randomized controlled trial",
abstract = "Aims Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. Methods and results A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32–93) years; the mean left ventricular ejection fraction was 0.38, and in 61{\%} it was ≤0.45{\%}. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1{\%}) compared with 25 (13.5{\%}) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan–Meier P = 0.151, hazard ratio (HR) 0.65, 95{\%} confidence interval (CI) 0.35–1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan–Meier P = 0.641, HR 0.89, 95{\%} CI 0.69–1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann–Whitney P < 0.001). Mortality was 18 (9.1{\%}) in the intervention group and 12 (6.5{\%}) in the usual-care group (Mann–Whitney P = 0.34, Cox regression analysis P = 0.82). Conclusion No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed.",
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Boyne, JJ, Vrijhoef, HJM, Crijns, HJGM, de Weerd, G, Kragten, J & Gorgels, APM 2012, 'Tailored telemonitoring in patients with heart failure: Results of a multicentre randomized controlled trial', European Journal of Heart Failure, vol. 14, no. 7, pp. 791-801. https://doi.org/10.1093/eurjhf/hfs058

Tailored telemonitoring in patients with heart failure : Results of a multicentre randomized controlled trial. / Boyne, J.J.; Vrijhoef, H.J.M.; Crijns, H.J.G.M.; de Weerd, G.; Kragten, J.; Gorgels, A.P.M.

In: European Journal of Heart Failure, Vol. 14, No. 7, 2012, p. 791-801.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Tailored telemonitoring in patients with heart failure

T2 - Results of a multicentre randomized controlled trial

AU - Boyne, J.J.

AU - Vrijhoef, H.J.M.

AU - Crijns, H.J.G.M.

AU - de Weerd, G.

AU - Kragten, J.

AU - Gorgels, A.P.M.

PY - 2012

Y1 - 2012

N2 - Aims Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. Methods and results A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32–93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan–Meier P = 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35–1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan–Meier P = 0.641, HR 0.89, 95% CI 0.69–1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann–Whitney P < 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann–Whitney P = 0.34, Cox regression analysis P = 0.82). Conclusion No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed.

AB - Aims Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. Methods and results A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32–93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan–Meier P = 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35–1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan–Meier P = 0.641, HR 0.89, 95% CI 0.69–1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann–Whitney P < 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann–Whitney P = 0.34, Cox regression analysis P = 0.82). Conclusion No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed.

U2 - 10.1093/eurjhf/hfs058

DO - 10.1093/eurjhf/hfs058

M3 - Article

VL - 14

SP - 791

EP - 801

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 7

ER -