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Remote management of heart failure: Herculean or Sisyphean task?
  1. Todd Dardas1,
  2. Michael P Dorsch2
  1. 1Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
  2. 2College of Pharmacy, University of Michigan Health System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Todd Dardas, Medicine, University of Washington, Seattle, WA 98195, USA; TDardas{at}cardiology.washington.edu

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Heart failure (HF) manifests as a severe functional limitation and myriad physiological derangements. Divining signals from this milieu is the domain of the HF specialist among whom there is an indelible belief that more effective HF care intrinsically arises from more communication, more measurement and, increasingly, more complex methods of acquiring and processing patient-generated data. Mobile technologies and electronically integrated systems of care eem to facillitate perfectly the steps of data generation, transmission, synthesis, interpretation, action and, ultimately, benefit to the patient. Unfortunately, realising improved outcomes among persons with HF enabled by outpatient monitoring has been elusive.

In this issue of Heart, Rahimi et al1 present results of a randomised trial designed to test whether centralised decision support optimised medical therapies and improved quality of life among patients compared with monitoring without centralised decision support. This hypothesis is of paramount importance. The authors’ study employs state-of-the-art blinding, randomisation, endpoint measurement and analysis to maximise the validity of their study. Nonetheless, the study ultimately could not conclude that expert support and alerts improved the primary outcome of medication use and dosing and quality of life compared with monitoring alone. The weighted change in medication optimisation demonstrated an improvement of 3% in the control group and 8% in the intervention group (p=0.20) …

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Footnotes

  • Twitter @ToddDardasMD

  • Contributors TD and MPD are the sole contributors to this editorial review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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