Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Heart Failure, 11(2), 191–206. https://doi.org/10.1016/j.jchf.2022.10.016 Dr. Christiane Angermann et al
Points
- A post-discharge remote telephone-based patient management approach combined with standard treatment did not affect the potential determinant of all-cause mortality and hospitalization in this randomized controlled study of participants after a hospital stay due to heart disease.
- Although the precise cause of this finding was unknown, prolonged results following the conclusion of the treatment indicated a potential death advantage with the telephone-based remote patient management technique when combined with conventional care.
Summary
The primary purpose of the trial was to assess the 18-month utilization of a remote medical management method in addition to standard care following cardiovascular events to ensure better results.
In the initial Interdisciplinary Network Heart Failure experiment, a controlled, randomized, and multicentered research study, a telephone-based, remote patient monitoring method was assessed in patients hospitalized following a cardiac arrest. At six months, there was no difference in the time of hospitalization or death from any cause. In the next part of this study, there were more patients and the intervention and follow-up periods were longer.
Participants were admitted between March 2004 and December 2008. To be eligible for the study, participants were supposed to be under 18, hospitalized for an acute heart failure aggravation, and have a left ventricular ejection fraction of less than 40%. Exclusion factors included a newly diagnosed mechanical cardiovascular disease and a refusal to participate in telephone-based therapies. Patients who had been recruited were randomly assigned to either the experimental remote patient monitoring group or the usual care group.
The remote patient monitoring therapy ended after 18 months. Regular treatment included advice on heart failure medication, suggestions for regular discharge planning, and a hospital visit every 7 to 14 days.
Follow-up meetings were held at the beginning of the study and again after 6, 12, 18, 36, 60, and 120 months. The primary combined result was the time until all-cause hospitalization, measured at 18 and 60 months. All-cause hospitalizations, sudden cardiac death, and modifications to wellness living standards were considered secondary results.
There was no difference in the outcome between the control and intervention groups. When the ongoing treatment ended after 18 months, all-cause mortality rates were roughly 20% for both groups. At 60 months, the all-cause mortality in the intervention group was reduced compared to the controls. When focusing only on stroke cases, similar mortality patterns were observed. At every follow-up appointment, the wellness of the intervention group improved.
Remote patient monitoring with standard and traditional care did not significantly lower all-cause death or hospitalization at 18 and 60 months after hospitalization due to heart failure.
Heart failure continues to be a significant concern for individuals and the medical system. The possibility of death and hospitalization after heart failure and its effect on well-being are significant concerns. Research on remote patient monitoring strategies has attempted to deal with these difficulties, but with varying degrees of effectiveness and contradictory data. Post-discharge care is complicated and frequently necessitates a coordinated effort among various disciplines and treatments.
Intriguingly, a long-term decrease in all-cause deaths persisted long after the active intervention ended. This may highlight a late benefit of this specific type of remote patient monitoring. To fully understand this discovery, further research is necessary.
Link to the article: https://www.jacc.org/doi/10.1016/j.jchf.2022.10.016
References Angermann, C. E., Sehner, S., Faller, H., Güder, G., Morbach, C., Frantz, S., Wegscheider, K., Ertl, G., & Störk, S. T. (2023). Longer-term effects of remote patient management following hospital discharge after acute systolic heart failure. JACC: Heart Failure, 11(2), 191–206. https://doi.org/10.1016/j.jchf.2022.10.016
