Clinical science: Special reports III News tips

November 16, 2010

Abstract 21829 - Automated remote patient monitoring fails to improve outcomes for heart failure patients

A remote monitoring system didn't help heart failure patients live longer or avoid return trips to the hospital, according to a new study.

The system required heart failure patients to dial into an automated, interactive voice response system daily to enter their weight and answer questions about heart failure symptoms. Clinicians managing patients' heart failure reviewed the information and called patients back to discuss worrisome reports. The remote monitoring system was compared with usual care based on national heart failure guidelines, which included heart failure education.

The six-month trial included 1,653 patients from around the United States who were within a month of being discharged from the hospital for decompensated heart failure. Participants' median age was 61 years, 39 percent were black and 42 percent were female.

Researchers tested whether use of the automated monitoring system would cut the incidence of hospitalization or death, and found no effect. The telephone calls also had no impact on heart failure hospitalizations, the number of hospital days or the number of hospitalizations. The death rate for the callers was 11.1 percent vs. 11.4 percent among those receiving usual care. The rate of rehospitalization was 49.3 percent for those using the telephone system and 47.4 percent for the usual care group. The rates of rehospitalization or death for any reason were 53.2 percent for the experimental group and 51.5 percent for the usual care group.

Although such automated systems for remote monitoring are being disseminated into practice with claims of effectiveness in improving outcomes, there appears to be no benefit in reducing readmissions or mortality for heart failure patients. Health systems are under increasing pressure to reduce hospital readmissions, but strategies to improve heart failure outcomes should be rigorously tested before adoption, researchers said.

Sarwat I. Chaudhry, M.D.; assistant professor of medicine, Yale University School of Medicine; New Haven, Conn.; (203) 785-265; sarwat.chaudhry@yale.edu. (Note: Actual presentation time is 3:45 p.m., CT, Tuesday, Nov. 16, 2010.)

Abstract 21855 - Faster life-saving treatment to treat heart attack patients noted after guidelines implemented

Physicians in North Carolina successfully restored blood flow in more heart attack patients and did so in less time after implementing a special statewide program to improve outcomes.

Researchers analyzed the months before with the months directly after a year-long program to implement American Heart Association/American College of Cardiology guidelines that promote prompt diagnosis and action throughout an area's hospital and emergency services system. This program is part of the American Heart Association's Mission: Lifeline.

The study consisted of a total of 6,822 patients who experienced a type of heart attack known as ST-segment elevation myocardial infarction or STEMI. A STEMI means there is a complete blockage of a heart artery, cutting off blood supply to the heart muscle. The time between EMS arriving at the scene of the heart attack to performing a percutaneous coronary intervention (PCI) and receiving the heart-saving intervention dropped from 103 minutes before the statewide program to 91 minutes after the program. Minutes were also shaved off the time it took patients to be transferred to a PCI-capable hospital. Overall, the death rate of patients in the hospital fell from the researchers' earlier 2006 study rate of 7.5 percent to below 6 percent. The rate of patients who were eligible for opening the blocked artery but were not treated dropped from 5.5 percent to 4 percent.

Christopher B. Granger M.D.; director, Cardiac Care Unit, Duke Clinical Research Institute; Durham, N.C.; (919) 668-8900; grang001@mc.duke.edu. (Note: Actual presentation time is 4 p.m., CT, Tuesday, Nov. 16, 2010.)

Editor's note: There are now nearly 500 STEMI systems across the country registered with the American Heart Association's Mission: Lifeline. To learn more, or to find a system near you, visit www.heart.org/missionlifeline.

Abstract 21787 - Blood pressure improved more when patients received specialized phone calls

More patients achieved recommended blood pressure control when given tailored calls urging them to exercise, eat right and take their medications as prescribed compared to those who received non-tailored calls or those who received the standard medical care. Researchers randomly assigned 533 patients with uncontrolled blood pressure to receive: calls tailored to their readiness to follow blood pressure treatment, non-tailored calls based on national blood pressure guidelines or the usual care (no phone calls) for patients with high blood pressure.

Those who received the specialized calls tailored to their readiness to follow treatment were more likely to have better control than those who received the non-tailored educational telephone calls or the usual care.

After six months, 62.3 percent of those who received the tailored calls got their blood pressure under control compared to 52.4 percent of those who received non-tailored calls and 47.2 percent who received standard care.

Sundar Natarajan, M.D.; staff physician; VA New York Harbor Healthcare System; New York, N.Y.; sundar.natarajan@va.gov. (Note: Actual presentation time is 4:15 p.m., CT, Tuesday, Nov. 16, 2010.)

Abstract 21835 - Results of telemonitoring for heart failure to be presented

Final results will be presented on a study designed to learn if remote patient management (telemedicine) could reduce death and hospitalization of heart failure patients. Researchers prospectively investigated if telephone support would reduce deaths by a third - as suggested in previous meta-analyses.

The two-year German study, Telemedical Interventional Monitoring in Heart Failure (TIM-HF) enrolled 710 patients with mild-to-moderate heart failure - meaning they had limitation of physical activity due to symptoms like fatigue or shortness of breath.

The participants were randomly assigned to either receive unprecedented 24-hour/7-day a week medical support from a dedicated telemedicine center with physicians and nurses or to receive the usual care from their local doctor. The telemedicine patients also received remote monitoring of their blood pressure, ECG and weight. They were followed for an average of two years. The median age of the patients was 67 years old and 19 percent were female.

Stefan Anker, M.D., Ph.D.; professor of cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germanay, (011) 49 - (0)30-450 553463; s.anker@cachexia.de. (Note: Actual presentation time is 4:30 p.m., CT, Tuesday, Nov. 16, 2010.)
-end-
Author disclosures are on the abstracts. Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

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