CLINICAL RESEARCH: HEART FAILURE
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
John G.F. Cleland, MD*,*,
Amala A. Louis, MD*,
Alan S. Rigby, PhD*,
Uwe Janssens, MD ,
Aggie H.M.M. Balk, MD TEN-HMS Investigators
* University of Hull, Kingston Upon Hull, United Kingdom
Universitätsklinikum, Aachen, Germany
Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
Manuscript received April 22, 2004;
revised manuscript received January 7, 2005,
accepted January 11, 2005.
* Reprint requests and correspondence: Prof. John G. F. Cleland, Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom (Email: j.g.cleland{at}hull.ac.uk).
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 randomly 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 randomly 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 randomly 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 randomly 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.
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Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | HTM = home telemonitoring | | LV = left ventricular | | NT-proBNP = N-terminal pro-brain natriuretic peptide | | NTS = nurse telephone support | | NYHA = New York Heart Association | | TEN-HMS = The Trans-European Network–Home-Care Management System | | UC = usual care | | WHARF = Weight Monitoring in Heart Failure |
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