Background: Chronic heart failure (CHF) is a common, serious, and costly disease whose clinical course is often characterized by recurrent hospitalizations due to fluid overload and/or worsening of renal function. Frequent (i.e. almost real-time) adjustments of treatment are needed to lower morbidity, mortality, and healthcare costs.
Purpose: To assess whether follow-up of CHF patients using telemonitoring (TM) vs. usual care (UC) impacts patient and economic outcome.
Methods: One hundred and sixty CHF patients (mean age 76±10 years, 104 males, mean left ventricular ejection fraction 35±15%) were block randomized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by TM or UC. The TM group measured body weight, blood pressure, and heart rate on a daily basis with electronic devices that transferred the data automatically to an online database. Email alerts were sent to the patients' general practitioner as well as to the heart failure centre to proactively intervene when pre-defined limits were exceeded. Individual healthcare costs were obtained from the Belgian healthcare expenditures database.
Results: All-cause mortality was significantly lower in the TM group than in the UC group (5% vs. 17.5%, P=0.01). The total number of follow-up days lost to hospitalization, dialysis, or death was significantly lower in the TM group as compared with the UC group (13 vs. 30 days, P=0.02). The number of hospitalizations for heart failure per patient showed a non-significant trend in favor of TM (0.24 vs. 0.42 hospitalizations/patient, P=0.06). Although the total drug and healthcare expenditures per patient/month were higher in the UC group than in the TM group (€678.28±1,246.02 vs. €477.72±1,239.04 and €5,392.76±8,084.40 vs. €4,327.30±10,021.00), the differences were not statistically significant.
Conclusion: Although the use of TM in a cohort of patients with severe chronic heart failure positively impacts clinical outcome, it does not reduce healthcare costs. A large randomized trial is, however, needed to confirm these findings.