Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF): study protocol for a randomized controlled trial Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Evaluation of a telemedicine system for heart failure patients: feasibility, acceptance rate, satisfaction and changes in patient behavior: results from the CARME (CAtalan Remote Management Evaluation) study The TeleGuard trial of additional telemedicine care in CAD patients. 2 Morbidity and mortality after 12 months A multidisciplinary telehealth program in patients with combined chronic obstructive pulmonary disease and chronic heart failure: study protocol for a randomized controlled trial [Noninvasive remote telemonitoring for ambulatory patients with heart failure: effect on number of hospitalizations, days in hospital, and quality of life. CARME (CAtalan Remote Management Evaluation) study]. Utilization of telemedicine by heart disease patients following hospitalization A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition - Heart Failure (BEAT-HF) randomized controlled trial A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. Telemonitoring with case management for seniors with heart failure. Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients With Chronic Heart Failure: The Telemedical Interventional Monitoring in Heart Failure Study Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure. A Randomized Trial of Telenursing to Reduce Hospitalization for Heart Failure: Patient-Centered Outcomes and Nursing Indicators Telemonitoring in patients with heart failure, the TEHAF study: Study protocol of an ongoing prospective randomised trial.
AIMS Remote patient management ( telemonitoring ) may help to detect early signs of cardiac decompensation , allowing optimization of and adherence to treatments in chronic heart failure ( CHF ) . Two meta-analyses have suggested that telemedicine in CHF can reduce mortality by 30 - 35 % . The aim of the TIM-HF study was to investigate the impact of telemedical management on mortality in ambulatory CHF patients . Methods CHF patients [ New York Heart Association ( NYHA ) II/III , left ventricular ejection fraction (LVEF)≤35 % ] with a history of cardiac decompensation with hospitalization in the past or therapy with intravenous diuretics in the prior 24 months ( no decompensation required if LVEF≤25 % ) were r and omized 1:1 to an intervention group of daily remote device monitoring ( electrocardiogram , blood pressure , body weight ) coupled with medical telephone support or to usual care led by the patients ' local physician . In the intervention group , 24/7 physician-led medical support was provided by two central telemedical centres . A clinical event committee blinded to treatment allocation assessed cause of death and reason for hospitalization . The primary endpoint was total mortality . The first secondary endpoint was a composite of cardiovascular mortality or hospitalization due to heart failure . Other secondary endpoints included cardiovascular mortality , all-cause and cause-specific hospitalizations ( all time to first event ) as well as days lost due to heart failure hospitalization or cardiovascular death ( in % of follow-up time ) , and changes in quality of life and NYHA class . Overall , 710 CHF patients were recruited . The mean follow-up was 21.5±7.2 months , with a minimum of 12 months . Perspective The study will provide important prospect i ve outcome data on the impact of telemedical management in patients with CHF Background Frequent rehospitalisations and poorer survival chances in heart failure ( HF ) patients may partly be explained by poor medication adherence . There are multiple medication-related reasons for suboptimal adherence , but psychological reasons may also be important . A novel TELEmonitoring device may improve MEDication adherence in HF patients ( TELEMED-HF ) . TELEMED-HF is a r and omized , controlled clinical intervention trial design ed to examine ( 1 ) the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients ' medication adherence ; ( 2 ) the effect of medication adherence on hospitalizations and health care consumption ; as well as on ( 3 ) clinical characteristics , and Quality of Life ( QoL ) ; and ( 4 ) clinical , sociodemographic , and psychological determinants of medication adherence . Methods / Design Consecutive patients with chronic , systolic HF presenting to the outpatient clinic of the TweeSteden Hospital , The Netherl and s , will be approached for study participation and r and omly assigned ( 1:1 ) following blocked r and omization procedures to the intervention ( n = 200 ) or usual care arm ( n = 200 ) . Patients in the intervention arm use the medication support device for six months in addition to usual care . Post-intervention , patients return to usual care only and all patients participate in four follow-up occasions over 12 months . Primary endpoints comprise objective and subjective medication adherence , healthcare consumption , number of hospitalizations , and cost-effectiveness . Secondary endpoints include disease severity , physical functioning , and QoL. Discussion The TELEMED-HF study will provide us a comprehensive underst and ing of medication adherence in HF patients , and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients .Trial registration numberNCT01347528 BACKGROUND Remote patient management in patients with heart failure might help to detect early signs and symptoms of cardiac decompensation , thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heart failure decompensation . We aim ed to investigate the efficacy of our remote patient management intervention on mortality and morbidity in a well defined heart failure population . METHODS The Telemedical Interventional Management in Heart Failure II ( TIM-HF2 ) trial was a prospect i ve , r and omised , controlled , parallel-group , unmasked ( with r and omisation concealment ) , multicentre trial with pragmatic elements introduced for data collection . The trial was done in Germany , and patients were recruited from hospitals and cardiology practice s. Eligible patients had heart failure , were in New York Heart Association class II or III , had been admitted to hospital for heart failure within 12 months before r and omisation , and had a left ventricular ejection fraction ( LVEF ) of 45 % or lower ( or if higher than 45 % , oral diuretics were being prescribed ) . Patients with major depression were excluded . Patients were r and omly assigned ( 1:1 ) using a secure web-based system to either remote patient management plus usual care or to usual care only and were followed up for a maximum of 393 days . The primary outcome was percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death , analysed in the full analysis set . Key secondary outcomes were all-cause and cardiovascular mortality . This study is registered with Clinical Trials.gov , number NCT01878630 , and has now been completed . FINDINGS Between Aug 13 , 2013 , and May 12 , 2017 , 1571 patients were r and omly assigned to remote patient management ( n=796 ) or usual care ( n=775 ) . Of these 1571 patients , 765 in the remote patient management group and 773 in the usual care group started their assigned care , and were included in the full analysis set . The percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause death was 4·88 % ( 95 % CI 4·55 - 5·23 ) in the remote patient management group and 6·64 % ( 6·19 - 7·13 ) in the usual care group ( ratio 0·80 , 95 % CI 0·65 - 1·00 ; p=0·0460 ) . Patients assigned to remote patient management lost a mean of 17·8 days ( 95 % CI 16·6 - 19·1 ) per year compared with 24·2 days ( 22·6 - 26·0 ) per year for patients assigned to usual care . The all-cause death rate was 7·86 ( 95 % CI 6·14 - 10·10 ) per 100 person-years of follow-up in the remote patient management group compared with 11·34 ( 9·21 - 13·95 ) per 100 person-years of follow-up in the usual care group ( hazard ratio [ HR ] 0·70 , 95 % CI 0·50 - 0·96 ; p=0·0280 ) . Cardiovascular mortality was not significantly different between the two groups ( HR 0·671 , 95 % CI 0·45 - 1·01 ; p=0·0560 ) . INTERPRETATION The TIM-HF2 trial suggests that a structured remote patient management intervention , when used in a well defined heart failure population , could reduce the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality . FUNDING German Federal Ministry of Education and Research AIMS Chronic heart failure ( CHF ) patients are frequently rehospitalized within 6 months after an episode of fluid retention . Rehospitalizations are preventable , but this requires an extensive organization of the healthcare system . In this study , we tested whether intensive follow-up of patients through a telemonitoring-facilitated collaboration between general practitioners ( GPs ) and a heart failure clinic could reduce mortality and rehospitalization rate . METHODS AND RESULTS One hunderd and sixty CHF patients [ mean age 76 ± 10 years , 104 males , mean left ventricular ejection fraction ( LVEF ) 35 ± 15 % ] were block r and omized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by telemonitoring ( TM ) or usual care ( UC ) . The TM group measured body weight , blood pressure , and heart rate on a daily basis with electronic devices that transferred the data automatically to an online data base . Email alerts were sent to the GP and heart failure clinic to intervene when pre-defined limits were exceeded . All-cause mortality was significantly lower in the TM group as compared with the UC group ( 5 % vs. 17.5 % , P = 0.01 ) . The total number of follow-up days lost to hospitalization , dialysis , or death was significantly lower in the TM group as compared with the UC group ( 13 vs. 30 days , P = 0.02 ) . The number of hospitalizations for heart failure per patient showed a trend ( 0.24 vs. 0.42 hospitalizations/patient , P = 0.06 ) in favour of TM . CONCLUSION Telemonitoring-facilitated collaboration between GPs and a heart failure clinic reduces mortality and number of days lost to hospitalization , death , or dialysis in CHF patients . These findings need confirmation in a large trial Background : Telemedicine can be useful for managing heart failure ( HF ) , but patient acceptance of telemedicine and its impact on patient behavior are unclear . Aims : To assess a telemedicine program in a HF Unit . Methods and results : This sub- analysis of the CARME study assessed the use of an interactive telemedicine platform . This prospect i ve intervention study had a before/after design with HF patients r and omized 1:1 into two groups : A ) Motiva system ( educational videos , motivational messages , and question naires ) ; and B ) Motiva system + telemonitoring of blood pressure  , heart rate and weight .  Of 211 patients screened , 44 were excluded , 62 did not consent to participate and 8 withdrew consent prior to installation of the system . The final study population included 97 patients . During 1 year of follow-up , 22 patients voluntarily discontinued use of the system , 5 died ( three after early discontinuation ) and 5 withdrew consent before the last evaluation . A total of 15,017 question naires were sent to patients , with a median response rate of 88 % . Satisfaction with the system and tools was high ( median score 8.4/10 ) , especially with the self-monitoring chart , scale and sphygmomanometer . Positive changes were observed in patient behavior , especially for blood pressure and weight control ( p < 0.001 ) . After the study , 65 % of the patients wished to continue with telemonitoring , particularly those in Group B ( p = 0.004 ) . Conclusion : Less than half of our patients participated in the telemedicine study . However , those who completed the study had confidence in the system , a high degree of satisfaction with the tools and positive behavioral changes Summary In the TeleGuard trial , 1500 patients with established coronary artery disease ( CAD ) were recruited and r and omized to control or intervention groups . Patients in the intervention group were equipped with a 12-lead event recorder and could contact a call centre and transmit an ECG whenever they wished . In a 12-month study , the composite endpoint ( all-cause mortality , myocardial infa rct ion , re-hospitalization or re-vascularization ) was seen in 40 % of the intervention patients and in 38 % of the control patients . In both groups , approximately 40 % were re-hospitalized . In total , 73 patients experienced re-vascularization , 75 showed an infa rct ion and 33 died . Equipping CAD patients with a 12-lead ECG device and providing a telemedicine centre with 24-hour availability did not decrease risk for the composite endpoint ( re-hospitalization , re-vascularization , ( subsequent ) myocardial infa rct ion and /or death ) . It is likely that the clinical pathway used in the telemedicine centre led to an increased hospital admission rate in the intervention group Background Chronic obstructive pulmonary disease ( COPD ) and chronic heart failure ( CHF ) frequently coexist , significantly reducing patients ’ quality of life and increasing morbidity and mortality . For either single disease , a multidisciplinary disease-management approach supported by telecommunication technologies offers the best outcome in terms of prolonged survival and reduced hospital readmissions . However , no data exist in patients with combined COPD /CHF.We planned a r and omized controlled trial to investigate the feasibility and efficacy of an integrated , home-based , medical/nursing intervention plus a rehabilitation program versus conventional care in patients with coexisting COPD /CHF . The purpose of the paper is to describe the rationale and design of the trial . Methods / design s Patients , after inpatient rehabilitation , were r and omly assigned to the intervention or control group , followed for 4 months at home , then assessed at 4 and 6 months . The intervention group followed a telesurveillance ( telephone contacts by nurse and remote monitoring of cardiorespiratory parameters ) and home-based rehabilitation program ( at least three sessions/week of mini-ergometer exercises , callisthenic exercises and twice weekly pedometer-driven walking , plus telephone contacts by a physiotherapist ) . Telephone follow-up served to verify compliance to therapy , maintain exercise motivation , educate for early recognition of signs/symptoms , and verify the skills acquired . At baseline and 4 and 6 months , the 6-min Walk Test , dyspnea and fatigue at rest , oxygenation ( PaO2/FiO2 ) , physical activity profile ( PASE question naire ) , and QoL ( Minnesota and CAT question naires ) were assessed . During the study , serious clinical events ( hospitalizations or deaths ) were recorded . Discussion Currently , no studies have assessed the impact of a telehealth program in patients with combined COPD and CHF . Our study will show whether this approach is effective in the management of such complex , frail patients who are at very high risk of exacerbations . Trial registration Network per la prevenzione e la sanità pubblica , CCM , Ministero della Salute “ Modelli innovativi di gestione integrata telegestita ospedale-territorio del malato cronico a fenotipo complesso : studio di implementazione , validazione e impatto , ” registered on 14 January 2014 . Clinical Trials.gov Identifier : NCT02269618 , registered on 17 October 2014 INTRODUCTION AND OBJECTIVES Multidisciplinary strategies for the management of heart failure ( HF ) improve outcomes . We aim ed to evaluate the effectiveness of noninvasive home telemonitoring in ambulatory patients with HF already included in a structured multidisciplinary HF program . METHODS Prospect i ve intervention study with before/after comparison design of an interactive telemedicine platform in HF patients , r and omized 1:1 into two groups : A ) Motiva System with educational videos , motivational messages , and question naires , and B ) Motiva System + self monitoring of blood pressure , heart rate , and weight . Hospitalizations were compared over 12 months prior to and post study inclusion . Quality of life was evaluated using the generic EuroQoL visual analogue scale and the specific question naire Minnesota Living With Heart Failure Question naire . RESULTS There were 92 patients included ( 71 % male ; 66.3 ± 11.5 years ; 71 % ischemic aetiology ) . During real-time telemonitoring over 11.8 months ( interquartile range 8.6 - 12 ) , 14,730 question naires were administered with 89 % median response rate . Hospitalizations for HF decreased by 67.8 % ( P = .010 ) and for other cardiac causes by 57.6 % ( P = .028 ) . The number of days in hospital for HF decreased by 73.3 % ( P = .036 ) , without statistically significant differences between groups , and for other cardiac causes by 82.9 % ( P = .008 ) . The perception of quality of life improved significantly both for the generic scale ( P < .001 ) and for the HF specific question naire ( P=.005 ) . CONCLUSIONS HF patients who used an interactive telehealth system with motivational support tools at home spent less time in hospital and felt their quality of life had significantly improved . No significant differences were observed between groups Summary NYHA class III and IV chronic heart failure has been established as a potential indication for telemedical care and monitoring already . We conducted a prospect i ve study to assess the utilization of telemedical services by cardiac patients in order to identify further indications . A total of 540 patients ( mean age 59 years ) with various heart diseases participated for at least 30 days in a home-based telemedicine service programme .  The two primary outcome measures were the rates of symptom-driven telephone calls ( A ) and ECG transmissions ( B ) per patient-year . The total follow-up was 68,649 days , with a median of 93 days . Symptomatic patients placed 713 calls and transmitted 221 ECGs . Poisson regression analysis with subset selection yielded four significant ( P < 0.05 ) independent positive predictors of the use of the telemedicine service : ( 1 ) recent repeat ( at least one previous ) percutaneous coronary intervention  ( A , P = 0.010 ; B , P = 0.001 ) ; ( 2 ) recent cardioversion for atrial fibrillation or flutter ( A , P < 0.0001 ; B , P < 0.0001 ) ; ( 3 ) ejection fraction ( A , P = 0.012 ; B , P > 0.05 ) ; and ( 4 ) reciprocal of age ( A , P < 0.0001 ; B , P > 0.05 ) . These data suggest that telemedicine may benefit patients following repeat percutaneous coronary intervention or cardioversion for atrial fibrillation . Since patients availed themselves of telemedicine service less with deteriorating ejection fraction and increasing age , individuals with chronic heart failure will need dedicated programmes , especially when they are older Background Heart failure is a prevalent health problem associated with costly hospital readmissions . Transitional care programs have been shown to reduce readmissions but are costly to implement . Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed . The objective of this r and omized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight , blood pressure , heart rate , and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure . Methods / Design A multi-center , r and omized controlled trial is being conducted at six academic health systems in California . A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure . Patients in the intervention group will receive intensive patient education using the ‘ teach-back ’ method and receive instruction in using the telemonitoring equipment . Following hospital discharge , they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a central ized call center . The nurses also will call patients and patients ’ physicians in response to alerts generated by the telemonitoring system , based on predetermined parameters . The primary outcome is readmission for any cause within 180 days . Secondary outcomes include 30-day readmission , mortality , hospital days , emergency department ( ED ) visits , hospital cost , and health-related quality of life . Discussion BEAT-HF is one of the largest r and omized controlled trials of telemonitoring in patients with heart failure , and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring . The study population also includes patients with a wide range of demographic and socioeconomic characteristics . Once completed , the study will be a rich re source of information on how best to use remote technology in the care management of patients with chronic heart failure . Trial registration Clinical Trials.gov # NCT01360203 OBJECTIVES We sought to determine whether a multidisciplinary outpatient management program decreases  chronic heart failure ( CHF )  hospital readmissions and mortality over a six-month period . BACKGROUND Hospital admission for CHF is an important problem amenable to improved outpatient management . METHODS Two hundred patients hospitalized with CHF at increased risk of hospital readmission were r and omized to a multidisciplinary program or usual care . A study cardiologist and a CHF nurse evaluated each patient and made recommendations to the patient 's primary physician before r and omization . The intervention team consisted of a cardiologist , a CHF nurse , a telephone nurse coordinator and the patient 's primary physician . Contact with the patient was on a prespecified schedule . The CHF nurse followed an algorithm to adjust medications . Patients in the nonintervention group were followed as usual . The primary outcome was the composite of the number of CHF hospital admissions and deaths over six months , compared by using a log transformation t test by intention-to-treat analysis . RESULTS The median age of the study patients was 63.5 years , and 39.5 % were women . There were 43 CHF hospital admissions and 7 deaths in the intervention group , as compared with 59 CHF hospital admissions and 13 deaths in the nonintervention group ( p = 0.09 ) . The quality -of-life score , percentage of patients on target vasodilator therapy and percentage of patients compliant with diet recommendations were significantly better in the intervention group . Cost per patient , in 1998 U.S. dollars , was similar in both groups . CONCLUSIONS This study demonstrates that a six-month , multidisciplinary approach to CHF management can improve important clinical outcomes at a similar cost in recently hospitalized high-risk patients with CHF BACKGROUND Telemonitoring , the use of communication technology to monitor clinical status , is gaining attention as a strategy to improve the care of patients with heart failure . A system of frequent monitoring could alert clinicians to early heart failure decompensation , providing the opportunity for intervention before patients become severely ill and require hospitalization . Moreover , patients ' participation in a daily monitoring program could have a favorable effect on their health behaviors . The literature on telemonitoring for heart failure , however , is quite limited . METHODS AND MATERIAL S Telemonitoring to Improve Heart Failure Outcomes ( Tele-HF ) is a r and omized , controlled , trial design ed to compare an automated , daily symptom , and self-reported weight monitoring intervention with usual care in reducing ( all-cause ) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure . The intervention will be implemented and all outcomes will be assessed over a 6-month period . The purpose of the intervention is to collect information about symptoms , clinical status and weight and to engage participants in their own self-care .  Participants are recruited from general cardiology , heart failure specialty , and primary care practice s across the United States . CONCLUSIONS The results of this study may inform future policy decisions regarding implementation of telemonitoring in treatment of heart failure OBJECTIVE To assess the impact of supplementing nurse case management with Internet-connected telemonitoring on clinical outcomes in an elderly heart failure ( HF ) population . STUDY DESIGN R and omized clinical trial allocating high-risk HF subjects to the telehealth system with case management ( THCM ) versus case management ( CM ) alone . METHODS Medicare Advantage members with HF and recent hospitalization were r and omized to THCM or CM . Consenting participants received THCM for 6 months or the health plan 's usual Medicare specialized CM as long as deemed necessary . The primary outcome measure was a composite of all-cause hospitalization , ED visit , or death . Because only a subset of those who were r and omized consented and participated , the strategies were evaluated as-treated rather than by intention-to-treat , with multivariate adjustment in logistic regression models for confounding introduced by postr and omization exclusions . RESULTS The treated sample size was 164 subjects in THCM and 152 in CM . Treatment arms did not differ significantly for the primary composite outcome ( 45 % for THCM vs 40 % for CM , relative risk 1.18 ; P = .22 ) . Telehealth alerts prompted frequent telephonic contact , increasing THCM case managers ' workload . The participant population overall had 42 % fewer inpatient days during the intervention period compared with the previous year . CONCLUSIONS Despite effective implementation of an Internet-based telehealth intervention in an elderly HF population , there was no discernible impact on overall morbidity or mortality . Notably , limited postr and omization participation decreased power to detect a difference . The reduction in days hospitalized for trial participants overall underscores the benefit of CM for such HF patients Background — This study was design ed to determine whether physician-led remote telemedical management ( RTM ) compared with usual care would result in reduced mortality in ambulatory patients with chronic heart failure ( HF ) . Methods and Results — We enrolled 710 stable chronic HF patients in New York Heart Association functional class II or III with a left ventricular ejection fraction ⩽35 % and a history of HF decompensation within the previous 2 years or with a left ventricular ejection fraction ⩽25 % . Patients were r and omly assigned ( 1:1 ) to RTM or usual care . Remote telemedical management used portable devices for ECG , blood pressure , and body weight measurements connected to a personal digital assistant that sent automated encrypted transmission via cell phones to the telemedical centers . The primary end point was death from any cause . The first secondary end point was a composite of cardiovascular death and hospitalization for HF . Baseline characteristics were similar between the RTM ( n=354 ) and control ( n=356 ) groups . Of the patients assigned to RTM , 287 ( 81 % ) were at least 70 % compliant with daily data transfers and no break for > 30 days ( except during hospitalizations ) . The median follow-up was 26 months ( minimum 12 ) , and was 99.9 % complete . Compared with usual care , RTM had no significant effect on all-cause mortality ( hazard ratio , 0.97 ; 95 % confidence interval , 0.67 to 1.41 ; P=0.87 ) or on cardiovascular death or HF hospitalization ( hazard ratio , 0.89 ; 95 % confidence interval , 0.67 to 1.19 ; P=0.44 ) . Conclusions — In ambulatory patients with chronic HF  , RTM compared with usual care was not associated with a reduction in all-cause mortality . Clinical Trial Registration : — URL : http://www . Clinical Trials.gov . Unique identifier : NCT00543881 BACKGROUND Telehealth has the potential to improve chronic disease management and outcomes , but data regarding direct benefit of telehealth in patients with heart failure ( HF ) have been mixed . The objective of this study was to determine whether the Health Buddy Program ( HBP ) ( Bosch Healthcare , Palo Alto , CA ) , a content-driven telehealth system coupled with care management , is associated with improved outcomes in Medicare beneficiaries with HF . MATERIAL S AND METHODS This was a retrospective cohort study of 623 Medicare beneficiaries with HF offered HBP enrollment compared with a propensity score-matched control group of Medicare beneficiaries with HF from the Medicare 5 % sample . Associations between availability of the HBP and all-cause mortality , hospitalization , hospital days , and emergency department visits were evaluated . RESULTS Beneficiaries offered enrollment in the HBP  had 24.9 % lower risk-adjusted all-cause mortality over 3 years of follow-up ( hazard ratio [ HR ] = 0.75 ; 95 % confidence interval [ CI ] , 0.63 - 0.89 ; p = 0.001 ) . Patients who used the HBP at least once ( 36.9 % ) had 57.2 % lower mortality compared with matched controls ( HR = 0.43 ; 95 % CI , 0.31 - 0.60 ; p < 0.001 ) , whereas patients who did not use the HBP had no significant difference in survival ( HR = 0.96 ; 95 % CI , 0.78 - 1.19 ; p = 0.69 ) . Patients offered the HBP also had fewer hospital admissions following enrollment ( Δ = -0.05 admissions/quarter ; p = 0.011 ) , which was primarily observed in patients who used the HBP at least once ( Δ = -0.10 admissions/quarter ; p < 0.001 ) . CONCLUSIONS The HBP , a content-driven telehealth system coupled with care management , was associated with significantly better survival and reduced hospitalization in Medicare beneficiaries with HF . Prospect i ve study is warranted to determine the mechanism of this association and opportunities for optimization ABSTRACT This trial compared 3  post-hospitalization nursing care models for reducing  congestive heart failure ( CHF ) readmission charges during 180-days of follow-up . Subjects received in-person visits at baseline and 60 days plus 1 of 3 care modalities in the interim : ( a ) video-based home telecare ; ( b ) telephone calls ; and ( c ) usual care .  CHF-related read-mission charges were > 80 % lower in the telenursing groups compared to usual care , and these groups also had significantly fewer CHF-related emergency visits . In-person visits were more than 3 times longer than telenursing visits ( p < 0.0001 ) , only partially due to added travel time . Patient self-care adherence , medications , health status , and satisfaction did not significantly differ between groups . Telenursing can reduce CHF hospitalizations and allow increased frequency of communication with patients 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 re sources and manpower , in the future the dem and 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 . DESIGN AND METHODS A prospect i ve r and omised controlled trial is carried out at 3 hospitals in the South-Limburg area in the Netherl and s. Primary outcome measures are hospital admissions and cost-effectiveness . Secondary outcomes are effects on therapy compliance , level of disease specific knowledge and quality of life . Also determinants are studied of most and less benefited patients in the intervention group . POWER CALCULATION : It is estimated that 390 patients have to be included in the study , with 185 in each arm . RESULTS Inclusion started in September 2007 with a follow-up time of 12 months . First results are expected at the end of 2010
Overall , telemedicine was shown to be beneficial , with home-based teletransmission effectively reducing all-cause mortality and HF-related hospital admission , length of stay and mortality in patients with HF
Telemedicine interventions may be associated with reductions in hospital admission rate and mortality in patients with heart failure ( HF ) .