Structured telephone support or telemonitoring programmes for patients with chronic heart failure
Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, Stewart S NFESC, Cleland JG FESC
Cochrane Database Syst Rev. 2010 Aug 4;8:CD007228
Synopsis
In the context of limited health funding, and a rapidly expanding population of older patients with chronic heart failure (CHF) it is increasingly difficult for healthcare systems to provide high-quality care to patients with CHF. Multi-disciplinary specialist heart failure clinics are available only to a minority of patients and do not have the capacity for frequent patient review. Patients may be unwilling or unable to make frequent clinic attendance due to financial, transport or disability constraints. Structured telephone support and telemonitoring can provide specialised heart failure care to a large number of patients with limited access to healthcare services. This review demonstrates that CHF interventions utilising information technology can reduce the rates of death and hospitalisation and improve the quality of life. The majority of elderly patients learned to use the technology easily and were satisfied with receiving healthcare in this way.
Commentary
Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.
Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure)
Mortara A, FESC, Pinna GD, Johnson P, Maestri R, Capomolla S, FESC, La Rovere MT, FESC, Ponikowski P, FESC, Tavazzi L, FESC, Sleight P, EFESC; HHH Investigators.
Eur J Heart Fail. 2009 Mar;11(3):312-8.
Synopsis
The study provides the data on feasibility and effectiveness in reducing cardiac events of home telemonitoring of clinical and physiological parameters in patients with systolic chronic heart failure. The self-managed home telemonitoring appeared to be feasible among the studied group, with a high compliance. Over a 12-month follow-up, there was, however, no significant effect of home monitoring administration in reducing bed-days occupancy for HF or cardiac death plus HF hospitalization, in comparison to usual outpatient care.
Commentary
Compliance is an important predictor of outcome among patients with chronic disease, including heart failure. Watchful monitoring of basic signs and symptoms (such as changes in body weight, pulse, blood pressure) and indirect supervision by medical staff using the telemedicine tools seems to be beneficial. Home telemonitoring appears to be particularly useful for patients with chronic heart failure, as the progressive deterioration of clinical status and frequent re-hospitalisations constitute inevitable elements of a natural history of this syndrome. The approach applied in the HHH Study has been proven to be feasible with a high level of the patients’ compliance. However, at least one important question has remained. Whether home telemonitoring can markedly reduce mortality and re-hospitalisations due to hearts failure deterioration require further studies.
Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study
Baumhäkel M, Müller U, Böhm M.
Eur J Heart Fail. 2009 Mar;11(3):299-303.
Synopsis
The paper demonstrates that both the patients’ and the physicians’ gender affect the treatment of patients with chronic heart failure (CHF). Generally male patients with CHF are more frequently treated with both beta-blockers (BB) and angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blocker (ARB) and receive higher doses of these drugs as compared to female patients. Interestingly, the use of ACE-I and/or ARB as well as the use of BB are lower in female patients treated by a male physician as compared with male patients treated by a female physician. Moreover, the doses of both ACE-I/ARB and BB are higher in male patients treated by a female physician than in female patients treated by a male physician. Female gender of a physician is an independent predictor of use of BB.
Commentary
Adherence to guidelines regarding among the others drug prescription is directly related to outcome in patients with chronic heart failure (CHF). Whereas the phenomenon of differences in management between men and women with cardiovascular disease is well established, the authors point out that the physician’s gender also may play a role. In general, female physicians treat better patients than their male colleagues. Awareness of this issue among physicians should help them to attenuate bias in the management of CHF patients. It seems to be worthy to further investigate the mechanisms responsible for this phenomenon.
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