Heart failure is a complex chronic condition that presents debilitating symptoms. It is a major public health problem across the globe, with more than 26 million people affected worldwide. In the United States and Europe, the prevalence of heart failure ranges between 1.1 and 2.2% in the general population. The toll is highest on those over 65, who make up more than 80% of deaths related to heart failure. It is believed that the lifetime probability of developing heart failure is one in five.
Clinical outcomes for heart failure patients depend primarily on how well people self-manage their condition between in-office visits with health care providers. Therefore, the lack of symptom monitoring and seeking treatment before there is an emergency may result in hospital readmissions in this group of patients.
The Lancet recently published the results of research by Prof. Dr. Friedrich Köhler and his team from Charité’s Centre for Cardiovascular Telemedicine. Their work is part of a research and development project called ‘Health Region of the Future North Brandenburg – Fontane.’ They conducted a trial involving 1,538 patients who suffer from chronic heart failure. The study covered all of Germany and included the collaboration of 113 cardiology care providers and 87 general practitioners.
Half of the patients received remote patient management interventions in addition to their regular care. The other half received traditional care only. The people in the remote patient management group were issued four devices: a blood pressure monitor; an ECG monitoring unit with a finger clip to measure oxygen saturation; a scale to measure body weight; and a tablet to record health data. The tablet transferred all data in real-time to Charité’s Telemedical Center, where a group of doctors and nurses was available around the clock to review the information. Out of range results led to specific steps such as adjusting the patient’s medication or recommending in-person care either at a doctor’s office or the hospital.
The goals of the study were to determine whether telemedicine could be used to avoid unplanned cardiovascular-related hospitalizations and whether its use had any impact on life expectancy. The researchers also wanted to know if the approach would increase patient quality of life by enabling them to self-manage more of their own care. Finally, the team was interested in testing whether remote patient management might help compensate for the difference between health care outcomes in rural and urban areas.
“The trial was able to show that the use of telemedicine can increase life expectancy,” explains Prof. Köhler. “As a next step, we would like to evaluate our data from a health economics perspective and identify where telemedicine might be able to deliver cost savings for our health care system. One year after the end of our study, we will also be evaluating whether telemedical interventional management has a lasting effect on disease progress even after the intervention has finished.”
The increased life expectancy finding was the same whether patients lived in metropolitan areas or rural areas with reduced access to healthcare. This shows that telemedicine is a promising strategy for compensating for regional differences in the healthcare infrastructure.
Similar Results in Italy
Last year a consensus document was released by the Italian Association of Hospital Cardiologists (A.N.M.C.O), the Italian Society of Cardiology (S.I.C.) and the Italian Society for Telemedicine and eHealth. It stated that telemedicine, as applied to heart failure patients, is a valuable tool for improving the patient’s prognosis and quality of life.
It stated, “Recently, several meta-analyses have shown that telemedicine-supported care pathways are not only effective but also economically advantageous. Benefits seem to be substantial, with a 30–35% reduction in mortality and 15–20% decrease in hospitalizations. Patients implanted with cardiac devices can also benefit from an integrated remote clinical management since all modern devices can transmit technical and diagnostic data.”
Telemedicine and Heart Failure in the United States
Heart failure is a significant public health problem in the United States with more than 5.8 million people affected. A recent policy statement of the American Heart Association on the telemedicine-based management of heart failure stated that effective programs need timely data, appropriate staff, and a feedback loop to patients with sufficient empowerment to understand and follow the proposed interventions.
Further research is clearly needed, but studies about the use of telemedicine for heart failure patients are very promising. The treatment of heart failure is just another on the long list of ways modern technology is transforming healthcare and positively impacting the lives of patients.