Heart failure non-invasive home telemonitoring systems: A systematic review.

BACKGROUND AND OBJECTIVE: Heart Failure (HF) is mostly a lifestyle-related disease that is suited to telemonitoring since patients' signs and symptoms can be assessed remotely by healthcare providers. Today, non-invasive telemonitoring programs are increasingly used in HF care to detect patients' deterioration. This study aims to review and assess the distinctive characteristics of the different telemonitoring systems (TMS) tested in HF patients through clinical trials (CTs). Discussing the impact of the evaluation results of these systems is also another objective of this work. METHODS: The search for CTs studies related to non-invasive home TMS in HF patients has been made in Cochrane Library. Research works of interest were limited to those articles published between 2005 and March 2019. RESULTS: A total of 24 CTs that fully met the inclusion criteria were included in the final review. The main functionalities of these TMS were analyzed and compared among them. Also, the monitored parameters and significant findings of each trial were described. CONCLUSIONS: This review shows a wide difference among available functionalities deployed by the reviewed systems. Most of them did not take into account the recommendations of HF management specialists, detailed in the evidence-based Clinical Practice Guidelines (CPGs) of the most relevant cardiology associations. Due to this, there is a wide variety of TMS, which makes a comparison among them difficult. However, the few systems that comply with the CPGs recommendations found promising results, suggesting that the design of TMS for the HF management should take into account the recommendations of specialists (CPGs).

Non-invasive home telemonitoring system for heart failure patients: A randomized clinical trial.

INTRODUCTION: The low quality of life in heart failure patients is related to low self-care and treatment adherence. Consequently, innovative strategies are needed to improve them. The objective of this work is to determine the effectiveness of the use of a home telemonitoring system to improve the self-care and treatment adherence of heart failure patients. METHODS: A randomized clinical trial that compares the efficacy of a home telemonitoring system -intervention group versus usual care control group - among heart failure outpatients over a 90-day monitoring period was carried out. The home telemonitoring system consists of an application that collects measurements of different parameters on a daily basis and provides health education to patients. The home telemonitoring system processes data gathered and generates an alert if a risky situation arises. The outcomes observed were significant changes in patients' self-care (European Heart Failure Self-care Behaviour Scale), treatment adherence (Morisky Modified Scale) and re-hospitalizations over the follow-up period. RESULTS: 104 heart failure patients were screened; 40 met the inclusion criteria; only 30 completed the study. After the follow-up, intragroup analysis of the control group indicated a decrease in treatment adherence (p = 0.02). The mean European Heart Failure Self-care Behaviour Scale overall score indicated an improved self-care in the intervention group patients (p = 0.03) and a worsened self-care in the control group (p = 0.04) with a p value of 0.004 in the intergroup analysis. Thanks to the home telemonitoring system alerts, two re-hospitalizations were avoided. DISCUSSION: This study demonstrated that the proposed home telemonitoring system improves patient self-care when compared to usual care and has the potential to avoid re-hospitalizations, even considering patients with low literacy levels.Trial Registration: Home Telemonitoring System for Patients with Heart Failure. clinicaltrials.gov Identifier: NCT04071093.