Two European telehealth studies, both with congestive heart failure patients presented results that were–how shall we say it–ambivalent about telehealth efficacy. The ‘Telemedicine to Improve Mortality in Heart Failure’ two-year study (TIM-HF) study from Charité Universitätsmedizin, Berlin, used a RPM system that cost €16 million (!) to develop–and found no significant benefits after 26 months of monitoring except for a sub-group with select physiological conditions. In the ‘Tailored Telemonitoring in Patients with Heartfailure’ (TEHAF) study, from Maastricht University Medical Centre (The Netherlands), Bosch’s Health Buddy was used for a CHF group over one year to provide feedback on symptoms, but no vital signs were transmitted save weight. The group with CHF for less than 18 months had significant improvement, but not so for those with a diagnoses more than 18 months old. But visits to nurses were fewer. Ed. Donna wonders how €16 million can be spent to design a CHF monitoring system which can come from a number of providers, and why the Dutch study didn’t use the full capability of Health Buddy. HealthcareITNews Hat tip to Laurie Orlov of Aging in Place Technology.
It should be understood that TIM-HF HF does not represent the realties of health care for patients with chronic heart failure in Germany.
(a) A large proportion of the patients included were already receiving a best of standard in terms of medical treatment (b) Patients were protected from sudden cardiac death due to heart disease by an implantable cardioverter defibrillator (ICD) in 45 percent (c) The control group received the best possible medical care and in addition had also to be sent to see their doctor every three months. It will not be possible to care for the total of around 2 million cardiac insufficiency patients in specialist cardiology centres in the Charité or in other hospitals.
These are both interesting studies (more detail for TEHAF can be found at http://www.escardio.org/congresses/HF2011/scientific/Documents/119-tehaf-Presenter.pdf)
What they provide us with is a better understanding of where HF telemonitoring is best targeted. TIM-HF suggested that optimally managed patients don’t get much benefit from telemonitoring, and TEHAF tells us that newer patients (who are at greater risk of re-admission, know less about their HF, and are still getting their medication regime stabilised)benefit more. The message for healthcare professionals working with HF telemonitoring seems to be that to achieve maximum clinical and economic benefits, you should recruit patients who are recently diagnosed, still lacking in knowledge and self-care ability, and not yet on the optimal medical therapy.
ERMI and David–thank you for sharing your conclusions which were based on far more information than what was available in the HIT article. For those in the telemonitoring field, these can be used as [u]guidance on effectiveness [/u] and targeting populations which would best benefit from RPM. Let us hope that these two studies, similar to last year’s NEJM/Yale HF study (using only inbound IVR!) some months back, are not taken as an invalidation of telehealth.