Remote management of heart failure using implantable electronic devices
Remote management of heart failure using implantable electronic devices
Aims: Remote management of heart failure using implantable electronic devices (REM-HF) aimed to assess the clinical and cost-effectiveness of remote monitoring (RM) of heart failure in patients with cardiac implanted electronic devices (CIEDs).
Methods and results: Between 29 September 2011 and 31 March 2014, we randomly assigned 1650 patients with heart failure and a CIED to active RM or usual care (UC). The active RM pathway included formalized remote follow-up protocols, and UC was standard practice in nine recruiting centres in England. The primary endpoint in the time to event analysis was the 1st event of death from any cause or unplanned hospitalization for cardiovascular reasons. Secondary endpoints included death from any cause, death from cardiovascular reasons, death from cardiovascular reasons and unplanned cardiovascular hospitalization, unplanned cardiovascular hospitalization, and unplanned hospitalization. REM-HF is registered with ISRCTN (96536028). The mean age of the population was 70 years (range 23-98); 86% were male. Patients were followed for a median of 2.8 years (range 0-4.3 years) completing on 31 January 2016. Patient adherence was high with a drop out of 4.3% over the course of the study. The incidence of the primary endpoint did not differ significantly between active RM and UC groups, which occurred in 42.4 and 40.8% of patients, respectively [hazard ratio 1.01; 95% confidence interval (CI) 0.87-1.18; P = 0.87]. There were no significant differences between the two groups with respect to any of the secondary endpoints or the time to the primary endpoint components.
Conclusion: Among patients with heart failure and a CIED, RM using weekly downloads and a formalized follow up approach does not improve outcomes.
Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews
Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews
Background
Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions
Objective
The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence.
Results
A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone–based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified.
Conclusions
Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone–based monitoring and videoconferencing, require further investigation.
Congress Moves the Chess Pieces
Politico | October 28, 2016
Excerpt:
Krista Drobac, of the Alliance for Connected Care, also shared tempered enthusiasm about a “great first step” given the constraints Senate Finance staff faced. She vowed to bring more information on savings — we’re assuming this is another reference to the CBO-inspired budget doubts about telemedicine.
Telemonitoring Reduced Costs and Inpatient Visitation Rates for Patients with Advanced Cardiovascular Disease: A Matched Cohort Study Telemonitoring Reduced Costs and in-Patient Visitation Rates for Patients with Advanced Cardiovascularddisease
Introduction: Reducing the cost of care of patients with cardiovascular disease is an important target for integrated health systems. Managing these patients is difficult and costly, with commensurately high rates of inpatient (IP) visitation.
Hypothesis: Medical costs and IP visitation rates of patients receiving remote telemonitoring (TM) will decrease, relative to what they would have otherwise been.
Methods: We performed a concurrent matched cohort study, comparing patients receiving TM to those who did not. Our treatment cohort includes all members of Priority Health, Grand Rapids, MI (PH) that received TM between January 2012 and September 2013. Members of the treatment cohort were matched 1:1 against non-TM members of PH, indexed on the month of TM enrollment. Matching criteria includes age and sex; chronic morbidity status (heart failure, COPD, HTN, diabetes); observed medical costs 12 and 6 months prior to initiation of TM; and IP utilization within 12 months prior to initiation of TM. Members were excluded from treatment and putative control cohorts if they did not have continuous enrollment for 12 months prior and 24 months post initiation of TM. Endpoints include 24 month cumulative medical cost and IP visitations.
Results: We provide population-level metrics (Table) with 80% confidence intervals for endpoint differences and average cumulative cost and inpatient visitation curves (Figure) for our treatment and matched control cohorts.
Conclusions: Remote telemonitoring of patients with advanced cardiovascular disease can reduce inpatientvisitation rates, driving a reduction in medical costs. In this study, we estimate a visitation rate reduction of 4.9%, and a medical cost reduction of $13,608 over 24 months.
Firms push to revise telemedicine law
ArkansasOnline | June 24, 2016
Excerpt:
The forum was moderated by Krista Drobac, director of the Alliance for Connected Care, a Washington, D.C., group that advocates for coverage of telemedicine by Medicare, Medicaid and private insurers.
Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials
Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials
Aims: To assess the overall effect of telemedicine on diabetes management and to identify features of telemedicine interventions that are associated with better diabetes management outcomes.
Methods: Hedges’s g was estimated as the summary measure of mean difference in HbA1c between patients with diabetes who went through telemedicine care and those who went through conventional, non-telemedicine care using a random-effects model. Q statistics were calculated to assess if the effect of telemedicine on diabetes management differs by types of diabetes, age groups of patients, duration of intervention, and primary telemedicine approaches used.
Results: The analysis included 55 randomized controlled trials with a total of 9258 patients with diabetes, out of which 4607 were randomized to telemedicine groups and 4651 to conventional, non-telemedicine care groups. The results favored telemedicine over conventional care (Hedges’s g=-0.48, p<0.001) in diabetes management. The beneficial effect of telemedicine were more pronounced among patients with type 2 diabetes (Hedges’s g=-0.63, p<0.001) than among those with type 1 diabetes (Hedges’s g=-0.27, p=0.027) (Q=4.25, p=0.04).
Conclusions: Compared to conventional care, telemedicine is more effective in improving treatment outcomes for diabetes patients, especially for those with type 2 diabetes.