Telemonitoring versus standard care in heart failure: a randomised multicentre trial

Area of Science:

• Cardiology
• Digital Health
• Health Services Research

Background:

• Heart failure (HF) poses a significant burden on healthcare systems, necessitating innovative management strategies.
• Telemonitoring offers a potential solution for remote patient management, aiming to improve outcomes and reduce hospitalizations.
• Previous studies have shown mixed results regarding the effectiveness of telemonitoring in HF management.

Purpose of the Study:

• To evaluate the efficacy of a telemonitoring program compared to standard care (SC) in preventing all-cause deaths or unplanned hospitalizations in patients with heart failure (HF) over 18 months.
• To identify subgroups of HF patients who may particularly benefit from telemonitoring interventions.

Main Methods:

• A randomized, multicenter, open-label study (OSICAT) involving 937 patients hospitalized for acute HF within 12 months prior to inclusion.
• Patients were randomized to either a telemonitoring group (daily weight and symptom monitoring, personalized education) or standard care (SC).
• Primary outcome: all-cause death or unplanned hospitalization at 18 months. Secondary outcomes included subgroup analyses based on NYHA class, social isolation, and adherence.

Main Results:

• The primary outcome did not differ significantly between the telemonitoring and SC groups (rate ratio 0.97, P=0.80).
• In patients with NYHA class III or IV HF, telemonitoring significantly reduced the time to all-cause death or first unplanned hospitalization (P=0.03).
• Telemonitoring was associated with a significant relative risk reduction in unplanned HF hospitalizations for NYHA class III-IV patients (HR 0.71), socially isolated patients (HR 0.62), and those highly adherent to weight monitoring (HR 0.63).

Conclusions:

• Telemonitoring, as implemented in this study, did not significantly reduce all-cause deaths or unplanned hospitalizations in the overall HF population.
• The study suggests that telemonitoring may improve clinical outcomes in specific HF patient subgroups, including those with advanced disease, social isolation, or high adherence to monitoring.
• Further research is warranted to confirm these subgroup findings and optimize telemonitoring strategies for targeted patient populations.