Introduction Patients with systolic heart failure are at high risk of admission to hospital and death. This can be reduced by ensuring that they are receiving all evidence-based heart failure medications and by detecting early signs of deterioration in their condition.
Methods Patients were enrolled from 2016 through 2017 at 12 GP practices across Buckinghamshire. Practices were selected if the used EMIS web as their electronic patient record and showed enthusiasm for participating in the study. At each practice, a senior heart failure nurse was deployed to identify patients with a REED code for heart failure and an echocardiographically determined ejection fraction (EF) of less than 40%. If no echocardiogram was available this was arranged. We recruited 209 primary care patients with echocardiographically proven left ventricular systolic dysfunction (ejection fraction<40%). 84 patients consented to be actively monitored by the heart failure team using telemedicine. It automatically uploaded any relevant data (weight, dyspnoea class, renal function, full blood count, urate, chest X-ray, repeat echocardiogram, hospital admissions, death) entered in the GP or hospital records. Patients were also encouraged to enter their own data (in particular weight and exercise tolerance). Clinicians were instructed to treat patients in accordance with national guidelines for the management of heart failure. 125 patients consented to receiving usual care but allowing access to their medical records. The primary end-point was cardiovascular death or admission to hospital for heart failure at 1 year. Secondary end-points included the prescription of evidence-based heart failure medications and patient satisfaction at the end of the study.
Results There was no difference in the mortality rate between the groups (6.02% in the active group and 5.56% in control). There was a significant difference in hospital admission (10.84% in the active group and 1.59% in control; p-value of 0.0078). At the end of the study, in the active group v control group, 92% v 52% of patients were on a beta-blocker, 92% v 48% on ACE-I/ARB, and 60% v 30% on an MRA. There were no differences in the final doses achieved.
Conclusions Active telemonitoring in an elderly population with systolic heart failure did not reduce cardiovascular mortality or admission to hospital for heart failure over the 1 year of the study. It did result in more patients receiving evidence-based heart failure medications. Overall satisfaction with active monitoring delivery a questionnaire was provided to all patients who opted to receive active monitoring. The purpose of the questionnaire was to determine overall satisfaction levels with the monitoring and identify areas for potential improvement. A questionnaire was circulated at the midpoint of the study (6 months) as well as at its conclusion (12 months). Of all patients in the active control group, a total of 27 completed both questionnaires (corresponding to 32.53% of all patients under active monitoring). The characteristics of this subset of the active cohort were consistent with the overall characteristics of all patients in the study; there was no significant differences in cardiovascular status (e.g., NYHA scores) or personal characteristics (e.g., gender, age).
The questionnaire consisted of a eleven questions measuring the patient satisfaction on various aspects of the active monitoring treatment. The overall response from patients was positive, with an average satisfaction of 8.54 / 10. Furthermore, when asked how likely they would be recommend the active monitoring treatment, patients gave an average score of 8.34 / 10.
Conflict of Interest None
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