Telemonitoring in Patients with Heart Failure

Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) was a multicenter, randomized, controlled trial designed to determine whether telemonitoring would reduce the combined end point of readmission or death from any cause among patients recently hospitalized for heart failure. What did you think about the findings published in the New England Journal of Medicine (NEJM)? The authors start by saying that "Small studies suggest that telemonitoring may improve heart-failure outcomes, but its effect in a large trial has not been established." Then, they conclude the paper with "Among patients recently hospitalized for heart failure, telemonitoring did not improve outcomes." Is this the final conclusion, or are we going to start over with the application and evaluation of newer telemonitoring technologies?

The authors definitely looked at a large sample of heart failure patients. 1653 patients were randomized to undergo either telemonitoring (826 patients) or usual care (827 patients). Telemonitoring was accomplished by means of a telephone-based interactive voice-response system that collected daily information about symptoms and weight that was reviewed by the patients' clinicians.

That type of telemonitoring technology sounds a bit archaic to me, but maybe it was considered "state of the art" for 2007. As we see advances in telemonitoring technology, what will we find in future studies?

Future of CDHP

I was having a discussion the other day about the future of consumer-directed (or driven) health plans (CDHP). We live in a world where managed care dominates the healthcare industry. Under this new administration, many things in the healthcare system will change. Some are talking about universal health coverage. Will that be like the VA (Veterans Affairs) system? Will be turn into Canada? No one seems to know the answers to these questions, but one thing is clear: we need to reduce healthcare costs and also improve disease management.

I personally believe that technology will help patients with disease self-management. If we look at some of the conditions that burden the healthcare system, they would include things such as: diabetes, heart disease, heart failure, COPD, asthma, and many others. Patients who have any of these conditions must be very active in caring for their conditions. They must adhere to their medication regimen. They must follow-up appropriately with their healthcare providers. The use of modern technology is improving the care of some of these conditions. Glucose monitors and insulin pumps are becoming more sophisticated. Cardiac devices are saving lives at home. Home monitoring devices are improving care for millions of patients. Patients are receiving education through the Internet (although they're also getting misinformation).

Well, I've obviously gone on a tangent, but I will return to this topic of CDHP in a later post.