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

Background—This study was designed 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 Յ35% and a history of HF decompensation within the previous 2 years or with a left ventricular ejection fraction Յ25%. Patients were randomly 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 (nϭ354) and control (nϭ356) groups. Of the patients assigned to RTM, 287 (81%) were at least 70% compliant with daily data transfers and no break for Ͼ30 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. Conclusions—In ambulatory patients with chronic HF, RTM compared with usual care was not associated with a reduction in all-cause mortality. C hronic heart failure (HF) results in poor life expectancy, impaired quality of life, and repeated hospitalizations, and represents a considerable economic burden to society. 1 Over the past years, the combination of an aging population and an escalation in healthcare costs has amplified the need for alternative care strategies for these patients. Disease management programs provided via HF clinics have been shown to reduce healthcare utilization and improve outcomes. 2 In the last decade, for patients with chronic HF, the focus has shifted as developments in modern telecommuni-cation technologies have created new options to deliver remote telemedical care. In chronic HF, remote telemedical management (RTM) can be used to optimize therapy, improve compliance, and enable early detection of cardiac decompensation. In the last decade, several clinical trials have been performed to assess the efficacy of telemedical monitoring to improve symptoms or quality of life. Two recent meta-analyses suggest that tele-medical monitoring of chronic HF patients can improve overall survival by 17% to 47% during 6 to 12 months of follow-up. …