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Tele-HF: Conflicting results reported for telemonitoring in patients with HF
Chaudhry S. N Engl J Med.2010;363:2301-2309.
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Patients with HF did not have improved outcomes as a result of telemonitoring, despite previous reports of a positive outcome with the strategy, according to a trial published in The New England Journal of Medicine.
“A recent Cochrane review concluded that telemonitoring of patients with HF reduced the rate of death from any cause by 44% and the rate of HF-related hospitalizations by 21%. However, the quality of the methods used in the studies was variable, and many of the studies were small,” the researchers wrote.
The randomized, controlled Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial included patients (n=1,653; mean age, 61 years) recently hospitalized for HF who were split into two arms: those who underwent telemonitoring (n=826) or usual care (n=827). The primary endpoint was defined as readmission for any reason or all-cause mortality 180 days after the enrollment.
During follow-up, the primary endpoint did not differ significantly between groups (telemonitoring, 52.3% vs. usual care, 51.5%). Specifically, rates of readmission for any reason were 49.3% in the telemonitoring group and 47.4% of patients in the usual-care group, whereas mortality rates were 11.1% in the telemonitoring group and 11.4% in the usual-care group.
“Previous claims of success of similar strategies, based on studies with small populations of patients and methodologic weaknesses, are not supported by the results of our large, multicenter trial,” the researchers concluded. “There remains a need for strategies to improve HF outcomes, and our findings indicate the importance of a thorough, independent evaluation of disease-management strategies before their widespread adoption.”
The Tele-HF trial showed no benefit at 6 months with telemonitoring-guided management compared with usual HF care. Specifically, from this study, we see no significant effect on hospital readmission or death from any cause, all-cause mortality, days in the hospital, or other important HF endpoints. This carefully designed study was larger and better-managed than previous smaller studies that suggested that telemonitoring could benefit hospital HF readmission rates. What this study demonstrates is that routine specialized HF medical therapy suffices in the benefit of HF patients. History and physical examination, along with routine HF nursing strategies, provide optimal care for these patients.
– Jon Kobashigawa, MD
Cardiology
Today Editorial Board Member
Dr. Kobashigawa has no relevant disclosures to report.
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