title: Clinical and psychological telemonitoring and telecare of high risk heart failure patients.
abstract: We conducted a trial of telemonitoring and telecare for patients with chronic heart failure leaving hospital after being treated for clinical instability. Eighty patients were randomized before hospital discharge to a usual care group (n=40: follow-up at the outpatient clinic) or to an integrated management group (n=40: patients learned to use a handheld PDA and kept in touch daily with the monitoring centre). At enrolment, the groups were similar for all clinical variables. At one-year follow-up, integrated management patients showed better adherence, reduced anxiety and depression, and lower NYHA class and plasma levels of BNP with respect to the usual care patients (e.g. NYHA class 2.1 vs 2.4, P<0.02). Mortality and hospital re-admissions for congestive heart failure were also reduced in integrated management patients (P<0.05). Integrated management was more expensive than usual care, although the cost of adverse events was 42% lower. In heart failure patients at high risk of relapse, the regular acquisition of simple clinical information and the possibility for the patient to contact the clinical staff improved drug titration, produced better psychological status and quality of life, and reduced hospitalizations for heart failure.
authors.affiliation: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Villani
authors.affiliation: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Malfatto
authors.affiliation: Dipartimento di Psicologia, Università degli Studi di Brescia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Compare
authors.affiliation: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Della Rosa
authors.affiliation: Istituto Nazionale dei Tumori IRCCS, Milano, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Bellardita
authors.affiliation: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Branzi
authors.affiliation: Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Molinari
authors.affiliation: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Italy gianfranco.parati@unimib.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
mesh_terms: D000359:Aftercare / Q000379:methods*; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology; D019033:Delivery of Health Care, Integrated / Q000379:methods; D003866:Depressive Disorder / Q000209:etiology; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000191:economics / Q000523:psychology / Q000628:therapy*; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011788:Quality of Life; D017216:Telemedicine / Q000191:economics