Role of telephone monitoring in patients with chronic heart failure: theory and practical implications

Figures & data

Figure 1 Main outcomes of large-scale trials of telemedical treatment in patients with chronic heart failure (A) TEN-HMS trial:²³ total mortality in each randomized group. (B) Tele-HF trial:²⁴ Kaplan–Meier time-to-event estimates for the primary endpoint of readmission for any reason or death from any cause. (C) TIM-HF trial:²⁵ Kaplan–Meier cumulative event curves for the primary endpoint of all-cause mortality. (D) CHAMPION:⁴¹ hospital admission due to cumulative heart failure during the entire period of randomised single-blind follow-up. Reprinted from The Lancet, 378(9792), Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. The Lancet, 731–739. Copyright © 2011, with permission from Elsevier.²¹ Copyright © 2011 Elsevier Ltd. All rights reserved.

Abbreviations: CI, confidence interval; RTM, remote telemedical management; TEN-HMS, Trans-European Network-Home-Care Management System; TIM-HF, Telemedical Interventional Monitoring in Heart Failure Study.

Figure 2 The Circle of Home Management of Heart Failure.

Notes: Many connections are required to allow for incorporation of physiological information obtained from patients at home to trigger interventions and potentially improve outcomes by means of heart-failure disease management. The telemonitoring intervention in the trial by Chaudhry et al²⁴ requires triangulation among the data-processing staff, the midlevel professional, and the physician before the patient is contacted to adjust therapy. A midlevel professional functioning independently may provide more timely feedback to the patient. Ideally, in the future, patients would be empowered to interpret and respond to their own physiological information. From the New England Journal of Medicine. Desai AS, Stevenson LW. Connecting the circle from home to heart-failure disease management, 363,2364–2367. Copyright © 2010 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.³⁸
Abbreviation: MD, medical doctor.

Figure 3 Heart failure sensor implanted through right heart catheterization in the right pulmonary artery (arrow), although left is the preferred location. Flow is noted around the sensor on venogram and the device measures pulmonary pressures. Obtained from Ohio State University Medical Center.

Cleland JGF, Louis AA, Rigby AS, Janssens U, Balk AH; TEN-HMS Investigators. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) Study. J Am Coll Cardiol. 2005;45:1654–1664.

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Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. Lancet. 2011;378:731–739.

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Desai AS, Stevenson LW. Connecting the circle from home to heart-failure disease management. N Engl J Med. 2010;363:2364–2367.

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