A study by the Cardiology Service’s Heart Failure Unit at the Hospital del Mar and IMIM (Hospital del Mar Medical Research Institute) has demonstrated that patients with chronic heart failure (HF) who are telephonically monitored have better results with regard to relapse and rehospitalisation than patients that receive conventional on-site follow-up. For six months the researchers used an electronic platform to analyse the evolution of a group of telephonically monitored patients, who used videoconferencing to communicate with the healthcare team. According to the study published in the Journal of Telemedicine and Telecare, the group being monitored using telemedicine also involved a 3,546 euro reduction in average cost per patient compared to the control group, over the six months of follow-up.
The study was designed and coordinated from the IMIM in collaboration with primary healthcare services in the area. The patients themselves were also involved in designing the technological solution.Two groups with the same protocols
The study was conducted using 178 patients suffering chronic HF, with an average age of 77. The participants were randomly assigned to one of the two monitoring models to be compared: a control group of 97 patients who had face-to-face appointments with the medical staff, and a telemedicine group of 81 patients where these meetings were held via videoconference. 25% of the sample set were fragile patients who were distributed between the two groups to ensure balanced allocation of participants in delicate health. “Both groups were monitored and treated in the same way in terms of the number of scheduled visits and content of the care, because both strategies shared the same protocols”, explains Dr. Josep Comín Colet, head of the Heart Failure Unit at the Hospital del Mar and a researcher in the IMIM’s cardiology group.
According to the researchers, this protocol is based on disease management involving nurse follow-up and encouraging patient self-care. “The aim is to promote the early detection and treatment of decompensation that could lead to future events related to heart failure, and therefore avoid readmissions and improve survival” contends Dr. Comín.
More efficiency at a lower cost
A committee that was unaware of which group each patient had been assigned to, to avoid bias, assessed the results of the two methods after the six months follow-up. “During the period analysed, the average number of non-serious decompensations requiring hospital treatment was significantly lower for the telemedicine group. Also, hospital readmissions for any cause and the average number of days in hospital was greatly reduced. Furthermore, the study has shown that the efficiency of telemedicine is independent of educational level, seriousness of the heart failure, presence of depression, and fragility of the patient”, emphasised the researcher.
In addition to the health results for the patients, the study also showed significant differences in the cost to the health system, with an average reduction in spending of 3,546 euros per patient for the telemedicine group. The calculation was made starting from the day after discharge from the hospital and included hospitalisation, diagnostic and ambulatory care costs.
Touchscreen tablets for patient monitoring
All the patients in the telemedicine group received a 3G-touchscreen tablet with a data collection system that also enabled them to have videoconferences. Through the virtual platform known as Tele-HealthCare (THC), the patient monitors their own health, directly posting their biometric data (weight, heart rate and blood pressure). It also provides information on their symptoms through a questionnaire that detects possible worsening of the illness as well as the state of their general health.In addition, the hospital app rings alarm signals when the biometric data go out of range. The nurses assigned to the telemedicine programme were responsible for collecting this information on a daily basis, to monitor each patient’s health and change the treatment if necessary.
A user-friendly device
One of the concerns of the research team was the use of the devices in the telemedicine group, considering that HF is an illness that particularly affects people over 65 years of age. Despite this, device-use was very high and less than 1 percent of the scheduled data transmissions were abandoned during the six months of the study. “We involved telecommunications engineers from Telefónica Solutions SA in the design of our solution, as well as doctors and patients, in order to develop an easy-to-use tool designed according to the needs of the patients”, explains Dr. Comín.
Despite all this, the study “still needs more research to assess whether the results could be generalised, explore the impact of this system on mortality, and determine the optimal duration of this type of intervention“, concludes the researcher. Heart failure is the inability of the heart to pump the volume of blood needed to meet the body’s demands and is the main cause of hospitalisation in people more than 65 years old.
This illness is not only common, affecting 2% of adults in developed countries, but also costly, disabling and potentially deadly.
Comín J*, Enjuanes C, Verdú JM, Linas A, Ruiz-Rodríguez P, González-Robledo G, Farré N, Moliner P, Ruiz-Bustillo S, Bruguera J. Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial. J TelemedTelecare 2015