In an interim analysis of a pilot study, ambulatory patients with
heart failure believed their disease was better controlled and may
have avoided hospitalizations by using a remote monitoring device to
regularly stay in touch with providers, who could observe their
vital signs and symptom status and recommend treatment adjustments
as needed [1].

The findings, which didn't reach statistical significance in the
small study, nonetheless suggest that a telemonitoring strategy as
part of a heart-failure disease-management program may benefit
patients who aren't limited to staying at home just as, in other
studies, it has helped the homebound with heart failure, according
to researchers who presented them here at the American Heart
Association 2008 Quality of Care and Outcomes Research in
Cardiovascular Disease and Stroke Conference.

The patients who used the telemonitoring system after discharge from
a heart-failure hospitalization had fewer all-cause and heart-
failure rehospitalizations over the next three months compared with
similar patients who received standard care. The six-month data,
which will be reported at a future meeting and submitted for
publication, "is even more optimistic about how the telemonitoring
is working," although they didn't achieve significance either,
according to Dr Ambar Kulshreshtha (Massachusetts General Hospital,
Boston), who led the study. Still, he told heartwire, the trends
seen at three months were strengthened in the six-month analysis.

Those trends appear consistent with earlier studies of
telemonitoring, generally used as part of a heart-failure disease-
management program, that have been covered by heartwire. Often, they
have suggested that remote telemonitoring, possibly by promoting
earlier treatment interventions as needed, may reduce patients'
risks of hospitalization and death, although the effects have not
always been significant.

There have also been suggestions in the earlier studies that remote
monitoring may make the most clinical difference for patients with
the severest disease. Kulshreshtha and his colleagues say their
findings were nonsignificant probably at least in part because
ambulatory patients have fewer events than homebound patients, and
longer follow-up is needed to show an effect from interventions.

Of 150 eligible patients, 68 were randomized to a usual-care control
group and 82 to remote monitoring as part of the Harvard-affiliated
Connected Cardiac Care Program (CCCP); of the 82, 42 patients or
their physicians declined to participate, leaving 40 in the
telemonitoring intervention group. Those who declined also received
usual care, according to Kulshreshtha.

The monitoring device (Turtle 400, Vitel Net) transmitted data on
patients' weight, pulse, blood pressure, and symptom status (based
on questions answered by the patient) to nurses, who could, with
physician oversight, manage any adjustments to therapy.

Kulshreshtha said the findings are helping CCCP physicians identify
and address what seem to be potential barriers to acceptance of
telemonitoring as a management strategy. For example, many of the
patients who refused participation said it was because they
were "uncomfortable" with the technology or because they were
planning travel away from home during the study period or otherwise
found it "hard to fit into their schedules."

The primary-care doctors who declined to participate, he said, often
cited reimbursement concerns: "How am I going to be compensated for
my time when there are all these data coming in?" Kulshreshtha said
he tries to explain that the telemonitoring nurse receives the
patient information and contacts the physician only as
necessary. "So there's really no increase in the physician's
workload."

And patients using the telemonitoring system generally report they
feel more connected with the nurses and their doctor, according to
Kulshreshtha, and "like it more than they expected to." In surveys
of the patients, virtually all reported "a high level of
satisfaction" and a sense of "improved heart-failure control," with
the device helping to keep them out of the hospital.

Kulshreshtha A, Nieves R, Kvedar JC, Watson AJ. Using information
technology to improve outcomes in patients with heart failure: The
value of remote monitoring. Quality of Care and Outcomes Research in
Cardiovascular Disease and Stroke Conference 2008; May 1, 2008;
Baltimore, MD. Abstract 21.