title: Simulated case management of home telemonitoring to assess the impact of different alert algorithms on work-load and clinical decisions First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure – CardioBBEAT 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 Rapid titration of carvedilol in patients with congestive heart failure: a randomized trial of automated telemedicine versus frequent outpatient clinic visits. 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. Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients With Chronic Heart Failure: The Telemedical Interventional Monitoring in Heart Failure Study Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial. Impact of Telemedical Care and Monitoring on Morbidity in Mild to Moderate Chronic Heart Failure Telecardiology for patients with chronic heart failure: the 'SHL' experience in Israel. A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial Telemonitoring in patients with heart failure. Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. Effectiveness of an interactive platform, and the ESC/HFA heartfailurematters.org website in patients with heart failure: design of the multicentre randomized e-Vita heart failure trial. Telephone support to rural and remote patients with heart failure: the Chronic Heart Failure Assessment by Telephone (CHAT) study. 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. Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure. Design and performance of a multisensor heart failure monitoring algorithm: results from the multisensor monitoring in congestive heart failure (MUSIC) study. Automated home telephone self-monitoring reduces hospitalization in patients with advanced heart failure
abstract: Background Home telemonitoring ( HTM ) of chronic heart failure ( HF ) promises to improve care by timely indications when a patient ’s condition is worsening . Simple rules of sudden weight change have been demonstrated to generate many alerts with poor sensitivity . Trend alert algorithms and bio-impedance ( a more sensitive marker of fluid change ) , should produce fewer false alerts and reduce workload . However , comparisons between such approaches on the decisions made and the time spent review ing alerts has not been studied . Methods Using HTM data from an observational trial of 91 HF patients , a simulated telemonitoring station was created and used to present virtual caseloads to clinicians experienced with HF HTM systems . Clinicians were r and omised to either a simple ( i.e. an increase of 2 kg in the past 3 days ) or advanced alert method ( either a moving average weight algorithm or bio-impedance cumulative sum algorithm ) . Results In total 16 clinicians review ed the caseloads , 8 r and omised to a simple alert method and 8 to the advanced alert methods .  Total time to review the caseloads was lower in the advanced arms than the simple arm ( 80 ± 42 vs. 149 ± 82 min ) but agreements on actions between clinicians were low ( Fleiss kappa 0.33 and 0.31 ) and despite having high sensitivity many alerts in the bio-impedance arm were not considered to need further action . Conclusion Advanced alerting algorithms with higher specificity are likely to reduce the time spent by clinicians and increase the percentage of time spent on changes rated as most meaningful . Work is needed to present bio-impedance alerts in a manner which is intuitive for clinicians Background Evidence that home telemonitoring for patients with chronic heart failure ( CHF ) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage . Methods Between January 2010 and June 2013 , patients with a confirmed diagnosis of CHF were enrolled and r and omly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system ( Motiva ® ) . The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio ( ICER ) established by the groups ’ difference in total cost and in the combined clinical endpoint “ days alive and not in hospital nor inpatient care per potential days in study ” within the follow-up of 12 months . Results A total of 621 predominantly male patients were enrolled , whereof 302 patients were assigned to the intervention group and 319 to the control group .  Ischemic cardiomyopathy was the leading cause of heart failure . Despite r and omization , subjects of the control group were more often in NYHA functional class III – IV , and exhibited peripheral edema and renal dysfunction more often . Additionally , the control and intervention groups differed in heart rhythm disorders . No differences existed regarding risk factor profile , comorbidities , echocardiographic parameters , especially left ventricular and diastolic diameter and ejection fraction , as well as functional test results , medication and quality of life . While the observed baseline differences may well be a play of chance , they are of clinical relevance . Therefore , the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances . Conclusions CardioBBEAT provides prospect i ve outcome data on both , clinical and health economic impact of home telemonitoring in CHF . The study differs by the use of a high evidence level r and omized controlled trial ( RCT ) design along with actual cost data obtained from health insurance companies . Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care . Overall , it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System . Trial registration Clinical Trials.gov NCT02293252 ; date of registration : 10 November 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 BACKGROUND Because of potential side effects and logistical difficulty of titrating medications , out patients with congestive heart failure rarely receive appropriate doses of carvedilol or other beta-blockers . To address these obstacles , we studied if an automated telemedicine system named TeleWatch ( TW ) could facilitate carvedilol titration in out patients with left ventricular systolic dysfunction . METHODS Forty-nine patients with New York Heart Association class II and III left ventricular systolic dysfunction , who were tolerating appropriate afterload-reducing therapy and not receiving beta-blockers , were enrolled into a 3-month study . Patients were r and omized to have clinic-only ( CO ) ( n = 24 ) carvedilol titration or titrations which combined clinic visits with TW monitoring ( n = 25 ) . All patients were seen in clinic biweekly , and those in the TW group were remotely monitored daily . Using a predefined algorithm , patients in the CO and TW groups were eligible for carvedilol titration on a biweekly or weekly basis , respectively , by physicians blinded to group assignment . RESULTS There was no statistical difference in the mean final daily dose of carvedilol between the CO and TW groups ( 39.4 vs 36.2 mg/d , P = .52 ) . Because remote telemedicine titrations were as successful as titrations in the clinic , the time to reach the final dose of carvedilol was significantly shorter in the TW group ( 33.6 vs 63.7 days , P < .0001 ) . There were 5 serious adverse events in the study , 4 of which were in the TW group ( P = .29 ) ; however , TW prospect ively detected 2 adverse events . CONCLUSIONS Remote monitoring with an automated telemedicine system can successfully facilitate titration of carvedilol in out patients with New York Heart Association class II and III congestive heart failure OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure 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 Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient 's home . The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions . Methods / design A primary care-based r and omised controlled trial will be carried out to assess the impact of a telemonitoring intervention aim ed at home care patients with heart failure ( HF ) and /or chronic lung disease ( CLD ) . The results will be compared with those obtained with st and ard health care practice . The duration of the study will be of one year . Sixty patients will be recruited for the study . In-home patients , diagnosed with HF and /or CLD , aged 14 or above and with two or more hospital admissions in the previous year will be eligible . For the intervention group , telemonitoring will consist of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight and body temperature . Additionally , the patients will complete a qualitative symptom question naire daily using the telemonitoring system . Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits . The control group will receive usual care . The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-r and omisation . The secondary outcome measures are : duration of hospital stay , hospital admissions due to HF or CLD , mortality rate , use of health care re sources , quality of life , cost-effectiveness , compliance and patient and health care professional satisfaction with the new technology . Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting . The study may contribute to enhance the underst and ing of alternative modes of health care provision for medically unstable elderly patients , who bear a high degree of physical and functional deterioration . Trial Registration IS RCT N : IS RCT AIMS This multicentre , r and omized controlled trial hypothesized that daily electronic transmission of body weight to a heart failure ( HF ) clinic will reduce cardiac hospitalization in patients recently hospitalized with HF . METHODS AND RESULTS A total of 344 patients were r and omized to either an  intervention group ( IG ) or a control group ( CG ) . Of the 319 patients included in the final analysis , the mean age was 73 years ( SD 10.2 ) , 75 % were males , and 57 % had a left ventricular ejection fraction ( LVEF ) < 30 % . Patients in both groups were recommended to weigh themselves daily and , in the case of sudden weight gain > 2 kg in 3 days , to contact the HF clinic . Patients in the IG were given an electronic scale and the weight was automatically transmitted to and monitored at the HF clinic . No significant differences were found for the primary endpoint , cardiac re-hospitalization [ 70/153 CG , 70/166 IG ; hazard ratio ( HR ) 0.90 , 95 % confidence interval ( CI ) 0.65 - 1.26 , P = 0.54 ] , or for the secondary endpoints , which included all-cause hospitalization ( 84/153 CG , 79/166 IG ; HR 0.83 , 95 % CI 0.61 - 1.13 , P = 0.24 ) , death from any cause ( 8/153 CG , 5/166 IG ; HR 0.57 , 95 % CI 0.19 - 1.73 , P = 0.32 ) , or the composite endpoint of cardiac hospitalization and death from any cause ( 78/153 CG , 75/166 IG ; HR 0.90 , 95 % CI 0.65 - 1.26 , P = 0.54 ) . Subgroup analyses did not show any benefits for patients in the IG despite their more frequent monitoring ; 398 occasions compared with 30 occasions in the CG . CONCLUSION Daily electronic transmission of body weight and monitoring three times a week did not decrease hospitalization or death in HF patients followed up at a HF clinic Objective : We investigated in a pilot study whether telemedicine is beneficial in mild to moderate chronic heart failure . Methods : A total of 128 patients with an ejection fraction ≤60 % and NYHA class II or III chronic heart failure were evaluated . Thirty-two patients were enrolled prospect ively in a staged telemedical service program .  Ninety-six controls were matched 3:1 to each telemedicine patient . Results : Median follow-up was 307 days ( range 104–459 ) . All-cause hospitalization duration [ 317 vs. 693 days/100 patient years ; relative risk ( RR ) 0.46 ; 95 % confidence interval ( CI ) 0.37–0.58 ; p < 0.0001 ) and rate ( 38 vs. 77/100 patient years ; RR 0.49 ; 95 % CI 0.25–0.95 ; p = 0.034 ) as well as cardiac hospitalization duration ( 49 vs. 379 days/100 patient years ; RR 0.13 ; 95 % CI 0.08–0.23 ; p < 0.0001 ] were significantly lower , cardiac hospitalization rate ( 11 vs. 35/100 patient years ; RR 0.31 ; 95 % CI 0.11–1.02 ; p = 0.058 ) tended to be lower in the telemedicine compared with the control group . Conclusion : These preliminary data suggest that telemedical care and monitoring may reduce morbidity in patients with NYHA class II and III chronic heart failure BACKGROUND Patients with chronic heart failure characteristically have multiple hospital admissions for symptom control , deleteriously affecting their quality of life and imposing a burden on national healthcare costs . We assessed the effect of a novel transtelephonic monitoring and follow-up program on the admission rate and length of hospital stay as well as changes in their subjectively rated quality of life of patients with chronic heart failure . METHODS This prospect i ve 1-year study was conducted on compliant subscribers to ' SHL ' , a telecardiological service with > 60,000 subscribers , who were admitted > or = 2 times during the previous year for recurrent pulmonary edema or deterioration in heart failure . Their heart rate , blood pressure and body weight measurements were now automatically transmitted daily to ' SHL"s data bank and added to stored and up date d medical records . A question naire survey acquired information on their quality of life . RESULTS The study cohort included 118 patients , mean age 75 years ( range 49 - 89 years ) , 65 % males , a II-IV class functional capacity and a 25 % ( range 10 - 39 % ) mean ejection fraction . There was a 66 % reduction in the total hospitalization days ( from 1623 in the year preceding study entry to 558 during the study period , p<0.0001 ) . Although only 38/118 patients were hospitalized , most participants reported a significant subjective improvement in their quality of life . CONCLUSIONS Data are provided to demonstrate that a transtelephonic system allowing primary care at the patient 's home can significantly reduce hospitalization rate and length of stay and significantly enhance the quality of life of patients with chronic heart failure Background Mobile health ( mHealth ) interventions may improve heart failure ( HF ) self-care , but st and ard models do not address informal caregivers ’ needs for information about the patient ’s status or how the caregiver can help . Objective We evaluated mHealth support for caregivers of HF patients over and above the impact of a st and ard mHealth approach . Methods We identified 331 HF patients from Department of Veterans Affairs outpatient clinics . All patients identified a “ CarePartner ” outside their household . Patients r and omized to “ st and ard mHealth ” ( n=165 ) received 12 months of weekly interactive voice response ( IVR ) calls including questions about their health and self-management . Based on patients ’ responses , they received tailored self-management advice , and their clinical team received structured fax alerts regarding serious health concerns . Patients r and omized to “ mHealth+CP ” ( n=166 ) received an identical intervention , but with automated emails sent to their CarePartner after each IVR call , including feedback about the patient ’s status and suggestions for how the CarePartner could support disease care . Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate . Self-care and symptom data also were collected through the weekly IVR assessment s. Results Participants were on average 67.8 years of age , 99 % were male ( 329/331 ) , 77 % where white ( 255/331 ) , and 59 % were married ( 195/331 ) . During 15,709 call-weeks of attempted IVR assessment s , patients completed 90 % of their calls with no difference in completion rates between arms . At both endpoints , composite quality of life scores were similar across arms . However , more mHealth+CP patients reported taking medications as prescribed at 6 months ( 8.8 % more , 95 % CI 1.2 - 16.5 , P=.02 ) and 12 months ( 13.8 % more , CI 3.7 - 23.8 , P<.01 ) , and 10.2 % more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up ( P=.048 ) . mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints ( both P<.05 ) , were consistently more likely to report taking medications as prescribed during weekly IVR assessment s , and also were less likely to report breathing problems or weight gains ( all P<.05 ) . Among patients with more depressive symptoms at enrollment , those r and omized to mHealth+CP were more likely than st and ard mHealth patients to report excellent or very good general health during weekly IVR calls . Conclusions Compared to a relatively intensive model of IVR monitoring , self-management assistance , and clinician alerts , a model including automated feedback to an informal caregiver outside the household improved HF patients ’ medication adherence and caregiver communication . mHealth+CP may also decrease patients ’ risk of HF exacerbations related to shortness of breath and sudden weight gains .  mHealth+CP may improve quality of life among patients with greater depressive symptoms . Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical , infrequent retrospective surveys . Trial Registration Clinical Trials.gov NCT00555360 ; https:// clinical trials.gov/ct2/show/NCT00555360 ( Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B ) BACKGROUND Small studies suggest that telemonitoring may improve heart-failure outcomes , but its effect in a large trial has not been established . METHODS We r and omly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either telemonitoring ( 826 patients ) or usual care ( 827 patients ) .  Telemonitoring was accomplished by means of a telephone-based interactive voice-response system that collected daily information about symptoms and weight that was review ed by the patients ' clinicians . The primary end point was readmission for any reason or death from any cause within 180 days after enrollment . Secondary end points included hospitalization for heart failure , number of days in the hospital , and number of hospitalizations . RESULTS The median age of the patients was 61 years ; 42.0 % were female , and 39.0 % were black . The telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point , which occurred in 52.3 % and 51.5 % of patients , respectively ( difference , 0.8 percentage points ; 95 % confidence interval [ CI ] , -4.0 to 5.6 ; P=0.75 by the chi-square test ) . Readmission for any reason occurred in 49.3 % of patients in the telemonitoring group and 47.4 % of patients in the usual-care group ( difference , 1.9 percentage points ; 95 % CI , -3.0 to 6.7 ; P=0.45 by the chi-square test ) . Death occurred in 11.1 % of the telemonitoring group and 11.4 % of the usual care group ( difference , -0.2 percentage points ; 95 % CI , -3.3 to 2.8 ; P=0.88 by the chi-square test ) . There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components . No adverse events were reported . CONCLUSIONS Among patients recently hospitalized for heart failure , telemonitoring did not improve outcomes . The results indicate the importance of a thorough , independent evaluation of disease-management strategies before their adoption . ( Funded by the National Heart , Lung , and Blood Institute ; Clinical Trials.gov number , NCT00303212 . ) 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 AIMS Electronic health support ( e-health ) may improve self-care of patients with heart failure ( HF ) . We aim to assess whether an adjusted care pathway with replacement of routine consultations by e-health improves self-care as compared with usual care . In addition , we will determine whether the ESC/HFA ( European Society of Cardiology/Heart Failure Association ) website heartfailurematters.org ( HFM website ) improves self-care when added to usual care . Finally , we aim to evaluate the cost-effectiveness of these interventions . METHODS A three-arm parallel r and omized trial will be conducted . Arm 1 consists of usual care ; arm 2 consists of usual care plus the HFM website ; and arm 3 is the adjusted care pathway with an interactive platform for disease management ( e-Vita platform ) , with a link to the HFM website , which replaces routine consultations with HF nurses at the outpatient clinic . In total , 414 patients managed in 10 Dutch HF outpatient clinics or in general practice will be included and followed for 12 months . Participants are included if they have had an established diagnosis of HF for at least 3 months . The primary outcome is self-care as measured by the European Heart Failure Self-care Behaviour scale ( EHFScB scale ) . Secondary outcomes are quality of life , cardiovascular- and HF-related mortality , hospitalization , and its duration as captured by hospital and general practitioner registries , use of and user satisfaction with the HFM website , and cost-effectiveness . PERSPECTIVE This study will provide important prospect i ve data on the impact and cost-effectiveness of an interactive platform for disease management and the HFM website . CLINICAL TRIAL REGISTRATION unique identifier : NCT01755988 BACKGROUND Heart failure ( HF ) remains a condition with high morbidity and mortality . We tested a telephone support strategy to reduce major events in rural and remote Australians with HF , who have limited healthcare access . Telephone support comprised an interactive telecommunication software tool ( TeleWatch ) with follow-up by trained cardiac nurses . METHODS Patients with a general practice ( GP ) diagnosis of HF were r and omized to usual care ( UC ) or UC and telephone support intervention ( UC+I ) using a cluster design involving 143 GPs throughout Australia . Patients were followed up for 12 months . The primary endpoint was the Packer clinical composite score . Secondary endpoints included hospitalization for any cause , death or hospitalization , as well as HF hospitalization . RESULTS Four hundred and five patients were r and omized to CHAT . Patients were well matched at baseline for key demographic variables . The primary endpoint of the Packer score was not different between the two groups ( P = 0.98 ) , although more patients improved with UC+I. There were fewer patients hospitalized for any cause ( 74 vs. 114 , adjusted HR 0.67 [ 95 % CI 0.50 - 0.89 ] , P = 0.006 ) and who died or were hospitalized ( 89 vs. 124 , adjusted HR 0.70 [ 95 % CI 0.53 - 0.92 ] , P = 0.011 ) , in the UC+I vs. UC group . HF hospitalizations were reduced with UC+I ( 23 vs. 35 , adjusted HR 0.81 [ 95 % CI 0.44 - 1.38 ] ) , although this was not significant ( P = 0.43 ) . There were 16 deaths in the UC group and 17 in the UC+I group ( P = 0.43 ) . CONCLUSIONS Although no difference was observed in the primary endpoint of CHAT ( Packer composite score ) , UC+I significantly reduced the number of HF patients hospitalized among a rural and remote cohort . These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients 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 Chronic heart failure ( CHF ) remains a common cause of disability , death and hospital admission . Several investigations support the usefulness of programs of disease management for improving clinical outcomes . However , the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown . The aim of the study was to determine whether a home-based telemanagement ( HBT ) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care ( UC ) follow-up programme over a one-year period . METHODS AND RESULTS Four hundred-sixty CHF patients ( pts ) , aged 57+/-10 years were r and omised to two management strategies : 230 pts to HBT programme and 230 pts to UC programme .  The HBT pts received a portable device , transferring , by telephone , a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation . The UC pts were referred to their primary care physicians and cardiologists . The primary objective of the study was one-year hospital readmission for cardiovascular reasons . During one-year follow-up 55 pts ( 24 % ) in HBT group and 83 pts ( 36 % ) in UC group had at least one readmission ( RR=0.56 ; 95 % CI : 0.38 - 0.82 ; p=0.01 ) . After adjusting for clinical and demographic characteristics , the HBT group had a significantly lower risk of readmission compared with the UC group ( HR=0.50 , 95 % CI : 0.34 - 0.73 ; p=0.01 ) . The intervention was associated with a 36 % decrease in the total number of hospital readmissions ( HBT group : 91 readmissions ; UC group : 142 readmissions ) and a 31 % decrease in the total number of episodes of hemodynamic instability ( 101 in HBT group vs 147 in UC group ) . The rate of hearth failure-related readmission was 19 % ( 43 pts ) in HBT group and 32 % ( 73 pts ) in UC group ( RR=0.49 , 95 % [ CI ] : 0.31 - 0.76 ; p=0.0001 ) . No significant difference was found on cardiovascular mortality between groups . Mean cost for hospital readmission was significantly lower in HBT group ( euro 843+/-1733 ) than in UC group ( euro 1298+/-2322 ) , ( -35 % , p<0.01 ) . CONCLUSIONS This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients BACKGROUND Remote monitoring of heart failure ( HF ) patients may help in the early detection of acute decompensation before the onset of symptoms , providing the opportunity for early intervention to reduce HF-related hospitalizations , improve outcomes , and lower costs . METHODS AND RESULTS MUSIC is a multicenter nonr and omized study design ed to develop and vali date an algorithm for prediction of impending acute HF decompensation with the use of physiologic signals obtained from an external device adhered to the chest . A total of 543 HF patients ( 206 development , 337 validation ) with ejection fraction ≤40 % and a recent HF admission were enrolled .  Patients were remotely monitored for 90 days using a multisensor device . Accounting for device failure and patient withdrawal , 314 patients ( 114 development , 200 validation ) were included in the analysis . Development patient data were used to develop a multiparameter HF detection algorithm . Algorithm performance in the development cohort had 65 % sensitivity , 90 % specificity , and a false positive rate of 0.7 per patient-year for detection of HF events . In the validation cohort , algorithm performance met the prespecified end points with 63 % sensitivity , 92 % specificity , and a false positive rate of 0.9 per patient-year . The overall rate of significant adverse skin response was 0.4 % . CONCLUSION Using an external multisensor monitoring system , an HF decompensation prediction algorithm was developed that met the prespecified performance end point . Further studies are required to determine whether the use of this system will improve patient outcomes We studied 138 patients admitted for heart failure ( HF ) . Patients were allocated one of three treatment strategies . Group 1 ( G1 , n = 50 ) were given usual care for HF , Group 2 ( G2 , n = 56 ) received a multi-disciplinary team approach , while Group 3 ( G3 , n = 32 ) had home telephone self-monitoring . Telemonitoring was based on the answers to three simple queries about bodyweight change , dyspnoea and general health . The system stratified the HF severity of each patient once a week , and recommended a prompt medical appointment or simple follow-up . Over a 12-month follow-up period , there were 43 adverse events ( cardiovascular deaths and rehospitalizations for HF : G1 = 22 , G2 = 14 , G3 = 7 ) . There was no difference between G2 and G3 ( P = 0.78 ) but there was significant disadvantage with usual care ( P = 0.02 vs. G2 and P = 0.04 vs. G3 ) . Time to re-admission for HF increased in G2 and G3 compared to G1 ( 188 and 198 days vs. 95 days , P = 0.03 and P = 0.02 respectively ) . Automated home telephone self-monitoring reduced rehospitalization in patients with advanced HF
target: St and ardised description of the telemonitoring algorithm can expedite the identification of key components in telemonitoring algorithms that allow accurate prediction of worsening heart failure
background: Introduction : Non-invasive telemonitoring programmes detecting deterioration of heart failure are increasingly used in heart failure care .
  Aim : The aim of this study was to compare different monitoring algorithms used in non-invasive telemonitoring programmes for patients with chronic heart failure .