Telemonitoring in Heart Failure Patients Treated by Cardiac Resynchronization Therapy with Defibrillator (CRT-D): the TELECART Study

Raiza Gandola, Mercer University College of Pharmacy

An analysis that evaluated 3,857,420 Medicare beneficiary patients over 65 years old who were hospitalized with heart failure found that little progress has been made in improving short-term mortality, with minimal improvements in long-term mortality in this patient population. [1]

Telemonitoring, as suggested in a review that analyzed its use in the management of chronic heart failure patients, is an effective tool in reducing the risk of all cause mortality and heart failure related hospitalizations. [2]

Telemonitoring involves remotely monitoring patients who are not at the same location as the health care provider, giving them the information necessary to manage patient’s conditions. As noted from patient feedback about the use of telemonitoring, its use has had a positive impact on their health giving them peace of mind that their condition is being closely followed. [3]

 

 

Title: Telemonitoring in heart failure patients treated by

cardiac resynchronisation therapy with defibrillator

(CRT-D): the TELECART Study

Telemonitoring in Heart Failure Patients Treated by Cardiac Resynchronization Therapy with Defibrillator (CRT-D): the TELECART Study

Design Multicenter, randomized, prospective study; N= 191
Objective To assess the impact of telemonitoring (TM) in improving clinical outcomes and CRT-D response
Study Groups TM in addition to standard care (n= 89); standard care without TM (n= 94)
Methods Enrolled patients had chronic heart failure lasting for at least three months, New York Heart Association (NYHA) functional class II or III, left bundle branch block, severe left ventricle ejection fraction reduction (LVEF <35%) and an indication for CRT-D treatment according to the American College of Cardiology/American Heart Association Task Force (ACC/AHA) guidelines.
Duration September 2010 through September 2014
Primary Outcome Measure All cause death, cardiac death; and hospital admission for heart failure
Baseline Characteristics TM Non-TM
Mean age, y 71.8 72.6
Male, n (%) 64 (71.9) 75 (79.8)
Hypertension, n (%) 52 (58.4) 57 (60.6)
Hypercholesterolemia, n (%) 61 (68.5) 45 (47.9)
Glucose, mg/dL 141.1 132.6
NYHA (II/III), n 37/52 46/48
Results TM Non-TM p-value
All cause mortality, n (%) 7 (7.9) 8 (8.5) 0.54
Cardiac death events, n (%) 3 (3.4) 5 (5.3) 0.39
Heart failure hospitalizations, n (%) 14 (15.7) 27 (28.7) 0.02
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: 1.05%
Study Author Conclusions Taken together, data indicate the importance of TM in predicting heart failure hospitalization in patients treated with CRT-D.

 

The study found a significant difference between hospitalization events in patients who received TM compared to patients who received standard treatment. After conducting a multivariate analysis of factors predicting heart failure hospitalizations, TM was the only factor predicting heart failure hospitalization [HR 0.6, 95% CI (0.42-0.79), p value= 0.002]. One limitation of this study is the small population size of patients treated by CRT-D, whether through TM or through standard treatment, as this is not representative of the whole patient population. Also, there were a number of patients lost during follow-up; two patients in the TM group discontinued the study while two others in the non-TM group were referred to other centers. Nevertheless, this study shows that telemonitoring could be an option to care for heart failure patients being treated with CRT-D.

 

References

  1. Kosiborod M, Lichtman JH, Heidenreich PA, et al. National Trends in Outcomes Among Elderly Patients with Heart Failure. The American Journal of Medicine: Cardiology. 2006;119(7):616e1-616e7. Accessed June 29, 2016.
  2. Inglis SC, Clark RA, Mcalister FA, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010;(8):CD007228.
  3. Telemonitoring NI. Introduction: Patient and Carers. http://www.telemonitoringni.info/. Accessed June 29, 2016.

 

 

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