Highlights
- •Clustering enables to stratify heart failure (HF) patients in 5 frailty clusters.
- •eHealth-based HF-care is effective regardless of the frailty phenotype.
- •Telemedicine (TM) tools in HF are cost-effective in the 5 described frailty strata.
- •Frailty should not be an exclusion criteria to engage patients in TM programmes.
Abstract
Background
The potential impact of telemedicine (TM) in the monitoring of patients with heart
failure (HF) is still uncertain particularly in the frailest patients. The aim of
this study was to define the efficacy of a TM-based managed care solution across different
HF patient frailty phenotypes.
Methods
We performed a clustering analysis on the basis of 8 frailty-related dimensions to
the HF-patients included in the ‘insuficiència Cardíaca Optimització Remota’ (iCOR) randomised study comparing TM vs. usual care (UC) in HF patients. The primary
study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion.
The healthcare-related costs in each study group and cluster were also evaluated.
The event rates of primary and secondary study endpoints were calculated for each
cluster. Cox proportional-hazards regression models were used to evaluate the effect
of cluster, treatment group and the interaction term cluster by treatment group on
study endpoints.
Results
5 different frailty phenotypes were identified. The positive effect of TM compared
to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly
lower in patients that underwent allocation to the TM arm compared to UC (p-value = 0.016). Ultimately, the healthcare costs were significantly reduced in patients
allocated to the TM compared to UC in all 5 frailty phenotypes (all p-value < 0.05).
Conclusions
Non-invasive TM-based follow-up tools are effective compared to UC follow-up in preventing
HF events in the early post-discharge period, regardless of the 5 frailty phenotypes.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations And Acronyms:
ACEI (angiotensin-converting-enzyme inhibitor), ADL (activities of daily living), AF (atrial fibrillation), APGAR (adaptability partnership growth affection resolve), ARB (angiotensin II receptor blocker), CI (confidence interval), CKD (chronic kidney disease), COPD (chronic obstructive pulmonary disease), COVID (SARS-CoV-2 disease), CV (cardiovascular), EEMs (least-square (marginal) means), eHealth (electronic health), EHFScBS (European heart failure self-care behaviour scale), GDS (geriatric depression scale), HF (heart failure), iCOR (insuficiència Cardíaca Optimització Remota), IQR (interquartile range), LVEF (left ventricular ejection fraction), mHealth (mobile health), MLHFQ (Minnesota living with heart failure questionnaire), MMSE (mini-mental state examination), MRA (mineralocorticoid receptor antagonist), NYHA (New York Heart Association), PROMs (patient reported measures), QoL (quality of life), TEN-HMS (Trans-European Network-Home-Care Management System), SD (standard deviation), SPAN-CHFII (Specialized Primary and Networked Care in Heart Failure), TM (telemedicine), UC (usual care)To read this article in full you will need to make a payment
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References
- Real world heart failure epidemiology and outcome: a population-based analysis of 88,195 patients.PLoS ONE. 2017; 12e0172745
- Epidemiology of heart failure.Eur J Heart Fail. 2020; 22: 1342-1356
- Health-related quality of life of patients with chronic systolic heart failure in Spain: results of the VIDA-IC study.Rev Esp Cardiol. 2016; 69 (Engl Ed): 256-271
- Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.Eur J Heart Fail. 2016; 18: 1132-1140
- Individual income, mortality and healthcare resource use in patients with chronic heart failure living in a universal healthcare system: a population-based study in Catalonia, Spain.Int J Cardiol. 2019; 277: 250-257
- Gender differences in health-related quality of life in patients with systolic heart failure: results of the VIDA multicentre study.J Clin Med. 2020; 9: 2825
- Transitions of care in heart failure: a scientific statement from the American heart association.Circ Heart Fail. 2015; 8: 384-409
- Transitions of care between acute and chronic heart failure: critical steps in the design of a multidisciplinary care model for the prevention of rehospitalisation.Rev Esp Cardiol. 2016; 69 (Engl Ed): 951-961
- Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients.Rev Esp Cardiol. 2014; 67 (Engl Ed): 283-293
- Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis.Ann Intern Med. 2014; 160: 774-784
- Telemedicine in heart failure: new insights from the Cochrane meta-analyses.Eur J Heart Fail. 2017; 19: 304-306
- Structured telephone support or non-invasive telemonitoring for patients with heart failure.Heart. 2017; 103: 255-257
- Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the trans-European network-home-care management system (TEN-HMS) study.J Am Coll Cardiol. 2005; 45: 1654-1664
- Telemonitoring in patients with heart failure.N Engl J Med. 2010; 363: 2301-2309
- A multicentre randomised controlled evaluation of automated home monitoring and telephonic disease management in patients recently hospitalised for congestive heart failure: the SPAN-CHF II trial.J Card Fail. 2010; 16: 285-292
- Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study.Circulation. 2011; 123: 1873-1880
- Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial.Lancet. 2018; 392: 1047-1057
- Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: results of a randomised controlled trial.J Telemed Telecare. 2016; 22: 282-295
- Impact of telemedicine on the clinical outcomes and healthcare costs of patients with chronic heart failure and mid-range or preserved ejection fraction managed in a multidisciplinary chronic heart failure programme: a sub-analysis of the iCOR randomised trial.J Telemed Telecare. 2020; 26: 64-72
- Study design of heart failure events reduction with remote monitoring and eHealth support (HERMeS).ESC Heart Fail. 2020; 7: 4448-4457
- The future of wearables in heart failure patients.JACC Heart Fail. 2019; 7: 922-932
- Applications of digital health for public health responses to COVID-19: a systematic scoping review of artificial intelligence, telehealth and related technologies.NPJ Digit Med. 2021; 4: 40
- 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; (Epub ahead of print): ehab368https://doi.org/10.1093/eurheartj/ehab368
- ESC e-cardiology working group position paper: overcoming challenges in digital health implementation in cardiovascular medicine.Eur J Prev Cardiol. 2019; 26: 1166-1177
- Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure.Eur J Heart Fail. 2016; 18: 869-875
- The frailty syndrome is associated with adverse health outcomes in very old patients with stable heart failure: a prospective study in six Spanish hospitals.Int J Cardiol. 2017; 236: 296-303
- Impact of frailty on mortality and hospitalisation in chronic heart failure: a systematic review and meta-analysis.J Am Heart Assoc. 2018; 7e008251
- Frailty is intertwined with heart failure: mechanisms, prevalence, prognosis, assessment, and management.JACC Heart Fail. 2019; 7: 1001-1011
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Frailty assessment in heart failure: an overview of the multi-domain approach.Curr Heart Fail Rep. 2018; 15: 17-23
- The family APGAR: a proposal for a family function test and its use by physicians.J Fam Pract. 1978; 6: 1231-1239
- The Duke-UNC functional social support questionnaire. measurement of social support in family medicine patients.Med Care. 1988; 26: 709-723
- The Minnesota living with heart failure questionnaire: comparison of different factor structures.Health Qual Life Outcomes. 2016; 14: 23
- Development and testing of the European heart failure self-care behaviour scale.Eur J Heart Fail. 2003; 5: 363-370
- Functional evaluation: the Barthel index.Md State Med J. 1965; 14: 61-65
- Assessment of older people: self-maintaining and instrumental activities of daily living.Gerontologist. 1969; 9: 179-186
- Development and testing of a five-item version of the geriatric depression scale.J Am Geriatr Soc. 1999; 47: 873-878
- "Mini-mental state". a practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.J Am Geriatr Soc. 1975; 23: 433-441
- Non-invasive telemonitoring improves outcomes in heart failure with reduced ejection fraction: a study in high-risk patients.ESC Heart Fail. 2020; 7: 3996-4004
- Literacy and health outcomes: a systematic review of the literature.J Gen Intern Med. 2004; 19: 1228-1239
- Event-free survival in adults with heart failure who engage in self-care management.Heart Lung. 2011; 40: 12-20
- Self-reported recall and daily diary-recorded measures of weight monitoring adherence: associations with heart failure-related hospitalisation.BMC Cardiovasc Disord. 2014; 14: 12
- Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis.Circulation. 2016; 133: 1189-1198
- The relationship between self-care, long term-mortality and heart failure hospitalization: insights from a real-world cohort study.Eur J Cardiovasc Nurs. 2021; (101093/eurjcn/zvab011 [ahead of print])
- Risk factors for hospital admission among older persons with newly diagnosed heart failure: findings from the cardiovascular health study.J Am Coll Cardiol. 2013; 61: 635-642
- Basal functional status predicts one-year mortality after a heart failure hospitalisation in elderly patients - the RICA prospective study.Int J Cardiol. 2018; 254: 182-188
- Effect of Barthel index on the risk of thirty-day mortality in patients with acute heart failure attending the emergency department: a cohort study of nine thousand ninety-eight patients from the epidemiology of acute heart failure in emergency departments registry.Ann Emerg Med. 2019; 73: 589-598
- Noncardiac comorbidity increases preventable hospitalisations and mortality among Medicare beneficiaries with chronic heart failure.J Am Coll Cardiol. 2003; 42: 1226-1233
- Predictors of early readmission or death in elderly patients with heart failure.Am Heart J. 2010; 160: 308-314
- Iron deficiency and health-related quality of life in chronic heart failure: results from a multicentre European study.Int J Cardiol. 2014; 174: 268-275
- Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases.Heart. 2011; 97: 1602-1606
- Relationship of depression to death or hospitalisation in patients with heart failure.Arch Intern Med. 2007; 167: 367-373
- Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure.Rev Esp Cardiol. 2008; 61: 835-842
- Caregiver well-being and patient outcomes in heart failure: a meta-analysis.J Cardiovasc Nurs. 2017; 32: 372-382
Article Info
Publication History
Published online: October 13, 2021
Accepted:
September 14,
2021
Received in revised form:
September 2,
2021
Received:
June 15,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
