La bitácora de Fran Sánchez Laguna
“Publican en JMIR un interesante estudio sobre las experiencias y percepciones de pacientes y médicos en un programa de telemonitorización en pacientes con insuficiencia cardíaca.
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Seto E et al, J Med Internet Res, 14(1)
Background:
Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.
Objectives:
The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.
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Hasan A, Paul V. European Heart Journal, 32(12)
Clinical management of refractory heart failure remains challenging, with a high rate of rehospitalizations despite advances in medical and device therapy. Care can be provided in person, via telehomecare (by telephone), or telemonitoring, which involves wireless technology for remote follow-up. Telemonitoring wirelessly transmits parameters such as weight, heart rate, or blood pressure for review by health-care professionals. Cardiac implantable devices (defibrillators and cardiac resynchronization therapy) also transmit continually interrogated physiological data, such as heart rate variability or intrathoracic impedance, which may be of value to predict patients at greater risk of hospitalization for heart failure.
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Bui AL, Fonarow GC. Journal of the American College of Cardiology, 59(2)
With a prevalence of 5.8 million in the United States alone, heart failure (HF) is a common syndrome associated with substantial morbidity, mortality, and healthcare expenditures. Close to 1 million HF hospitalizations occur annually in the United States, with the majority of these resulting from worsening congestion in patients previously diagnosed with HF. An estimated $37.2 billion is spent each year on HF in the United States. These statistics emphasize the need to develop and implement more effective strategies to assess, monitor, and treat HF. It has also become increasingly apparent that interventions geared toward identifying and monitoring subclinical congestion would be of value in the home management of chronic HF.
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Healthcare Technology Online
“InterComponentWare, Inc., a leading international provider of healthcare information technology, has been honored with the 2011 Karl Storz prize for Telemedicine by The German Society for Telemedicine through its participation in the prestigious German “Partnership for the Heart” consortium.
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Anker SD et al, The Lancet, 378(9806)
We agree with Alexander Clark and David Thompson about the complexity of telemedicine and remote patient management interventions and that in many cases “interventions with the same label are not the same interventions”. Hence we proposed the concept of “four generations of telemedicine” in our Review. We maintain that the effectiveness of telemedicine and remote patient management in heart failure is not established.
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Inglis SC et al, The Lancet, 378(9806)
We commend Stefan Anker and colleagues on their excellent Review of telemonitoring in chronic heart failure (CHF) and on their proposed classification of telemedical remote management systems according to the type of data transfer, decision ability, and level of integration.
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Clark AM, Thompson DR. The Lancet. 378(9806)
“Everything works” or “nothing works”: clinicians often grapple with these dichotomous and non-qualified conclusions in systematic reviews. Seldom does this occur in the same paper.
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Connelly DP et al, J Am Med Inform Assoc, 2011
Objective
To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED).
Materials and methods
We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate.
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Cristiano Codagnone, Ioannis Maghiros, David Broster, Francisco Lupiañez, Maria Lluch, JRC
“This report contains the main findings of the scoping and exploratory research carried out in the course of 2010 by the SIMPHS research team (part of the TIESC Action within the Information Society Unit at IPTS1) on the broadly defined issue of assessing the micro and macro impact of Integrated Personal Health and Social Care Services (IPHS, see infra § 1.1 for the definition). SIMPHS, which stands for Strategic Intelligence Monitor of Personal Health Systems, is a three-year project collaboration between IPTS and Unit H1 (ICT for Health) of the European Commission’s Directorate General Information Society.
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Emily Singer, Technology Review
“A smart-phone app under development for heart-failure patients allows them to keep track of the pressure inside their heart as measured by an implanted sensor. That data could help patients adjust their medication to maintain a healthy pressure, much as diabetics do with insulin and blood sugar readings.
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Kurtz B et al, Journal of Telemedicine and Telecare, 17(6)
We studied 138 patients admitted for heart failure (HF). Patients were allocated one of three treatment strategies. Group 1 (G1, n = 50) were given usual care for HF, Group 2 (G2, n = 56) received a multi-disciplinary team approach, while Group 3 (G3, n = 32) had home telephone self-monitoring. Telemonitoring was based on the answers to three simple queries about bodyweight change, dyspnoea and general health. The system stratified the HF severity of each patient once a week, and recommended a prompt medical appointment or simple follow-up.
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Anker SD et al, The Lancet, 378(9792)
Advances in telecommunication technologies have created new opportunities to provide telemedical care as an adjunct to medical management of patients with heart failure. Meta-analyses suggest that telemedicine can reduce morbidity and mortality in such patients; however, two prospective clinical trials not included in the analyses do not support these findings. Therefore, the effectiveness of telemedicine in heart failure is not established. Telemedicine approaches range from computer-based support systems to programmes led by nurses and physicians. Standardisation and appropriate classification of telemedical systems are needed to enable accurate interpretation of clinical trials.
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Shanna Crispin, e-Health Insider
“NHS Bristol is to take advantage of mobile technology as it rolls out a new telehealth service to patients with long-term conditions.
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Sara Jackson, FierceMobileHealthcare
“After finding no overall benefit for congestive heart failure patients using telemedicine, researchers of a Dutch and a German telehealth study, respectively, decided to dig a little deeper.
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CMIO
“Telemonitoring can benefit certain patients with congestive heart failure patients, according to two trials presented at the Heart Failure Association of the European Society of Cardiology’s Heart Failure Congress 2011, in Gothenburg, Sweden.
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Boyne JJJ et al, International Journal of Nursing Studies, 48(1)
BACKGROUND
As the prevalence of heart failure (HF) rises sharply, the costs related to the care of these patients increases in parallel. Considering the already limited resources and manpower, in the future the demand for care may exceed the supply. Therefore, health care systems are encouraged to develop innovative strategies to deal with the burden of HF to improve the quality of care in order to medical outcomes and patients’ quality of life. For that reason new management systems – such as telemonitoring – have to be explored.
OBJECTIVES
This paper outlines the study protocol of a tailor-made telemonitoring program in ambulant patients with HF.
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Seto E et al, J Med Internet Res, 12(4)
BACKGROUND
Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology.
OBJECTIVE
The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring.
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Adriana Barton, Globe and Mail
“Ever since he was diagnosed with heart failure three years ago, Gary Bushby has had a new morning ritual. Not a crumb passes his lips before he weighs himself, takes his blood pressure and logs on to a hospital website to tell a computer program how he’s feeling.
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EurekAlert!
“Two trials presented at the Heart Failure Congress 2011, organized by the Heart Failure Association of the European Society of Cardiology (HFA of the ESC), will help to define the precise populations of patients with chronic heart failure (CHF) in whom telemedical management delivers benefits. Both the TIM-HF and TEHAF studies – presented in Late Breaking Session 1 – revealed that telemonitoring showed significant benefits in defined subgroups of patients. The results, which will be used to help in the design of future trials, come after the overall results from both trials demonstrated no statistical benefit for telemonitoring.
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