title: Tailored telemonitoring in patients with heart failure: results of a multicentre randomized controlled trial.
abstract: OBJECTIVE
  Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations.
  
  
  RESULTS
  A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32-93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan-Meier P = 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35-1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan-Meier P = 0.641, HR 0.89, 95% CI 0.69-1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann-Whitney P < 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann-Whitney P = 0.34, Cox regression analysis P = 0.82).
  
  
  CONCLUSIONS
  No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed.
  
  
  BACKGROUND
  NCT00502255.
authors.affiliation: Department of Patient & Care, Maastricht University Medical Centre, & CAPHRI, The Netherlands. j.boyne@maastrichtuniversity.nl
authors.forename: Josiane J J
authors.initials: JJ
authors.lastname: Boyne
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Gerjan
authors.initials: G
authors.lastname: De Weerd
authors.forename: Johannes
authors.initials: J
authors.lastname: Kragten
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D013318:Stroke Volume; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016277:Ventricular Function, Left