NEW TELEMEDICINE techniques allow patients with heart failure to be safely cared for at home. A European study, announced in Hot Line session I, demonstrated that the system could monitor patients’ risk factors, respiration and vital signs, without the need for hospital appointments. Patients were enthusiastic about the system and even those who were elderly and unused to technology were able to comply and successfully carry out the vast majority of data transmissions, according to Andrea Mortara ( Milan , Italy ), who led the research.
The study, known as the Home or Hospital in Heart failure trial (HHH), is the largest telemedicine study to date. It was funded by the European Commission and included 461 patients from Italy, Poland and the UK. They had a mean age of 60 years (+/- 11 years), were NYHA class 2.4 (+/- 0.6) and had a left ventricular ejection fraction of 29 (+/-7%). They were followed for a year. All patients received the usual care and those randomised to participate in telemonitoring were given a special telephone line, digital scales and an automatic blood pressure monitor. Three telemonitoring strategies were studied. The first was simple voice contact by telephone.
The second also included intermittent monitoring of vital signs; and the third further added periodic 24-hour continuous monitoring of ECG respiration and physical activity using a self-positioning recorder. In Italy, Poland and the UK, respectively, 82%, 75% and 93% of vital signs transmissions – involving a total of 50,217 parameters and 686 voice messages – were successfully carried out by patients. At the most detailed level of telemonitoring, at least 85% of recordings were successfully transmitted.
Mortara concluded that self-managed home telemonitoring was feasible in heart failure patients and had further benefits: “The system does not just collect information, but by doing so, it encourages patients to change their behaviour. It pushes patients to control their blood pressure, weight, and to take care of themselves.”
- Although the ACCLAIM study, presented at the same Hot Line session, failed to meet its primary endpoint, a subgroup analysis showed benefits for CelacadeTM immunotherapy, which targets inflammation in heart failure patients. Guillermo Torre-Amione, from The Methodist Hospital (Houston, Texas, US) said that a subgroup analysis of 689 NYHA class II patients showed this novel therapy reduced the risk of mortality or cardiovascular hospitalisation by 39% compared to controls receiving usual therapy (P=0.0003). CelacadeTM immunotherapy involves ex-vivo treatment of a sample of the patient’s blood to promote apoptosis. When reintroduced to the patient, the sample induces a decrease in inflammatory cytokines and an up-regulation of anti-inflammatory cytokines, and the combined effect is thought beneficial in heart failure. The therapy was found to be safe and well tolerated.
- The Perindopril in Elderly People with Chronic Heart Failure (PEP-CHF) study, involving 850 patients of 70 years or older, showed that the ACE inhibitor, perindopril, improved symptoms and exercise capacity and led to fewer hospitalisations for heart failure in the first year of treatment. John Cleland (
Hull, UK) led the study. He said: “Although this study lacked sufficient statistical power to show that perindopril reduces long-term morbidity and mortality, the results suggest that perindopril treatment is of benefit in this elderly population.”
Source: ESC Congress News, Monday 04 September 2006