title: If home telemonitoring reduces mortality in heart failure, is this just due to better guideline-based treatment?
abstract: To investigate, in a 'real-world' setting, the impact of home telemonitoring (HTM) compared to usual care on achieved dose of guideline-recommended medication, hospitalisation rate and mortality in patients with heart failure (HF).
  
  
  METHODS
  We retrospectively analyzed data on 333 patients with HF referred to a HTM service supported by a nurse-specialist (mean age 71±12 years, mean left ventricular ejection fraction (LVEF) 36 ± 11% and median N-Terminal pro B-type Natriuretic Peptide (NT-proBNP) 2,972 ng/L (interquartile range (IQR): 1,447-7,801 ng/L)). Most patients (n = 278) accepted HTM (HTM-group) but 55 refused and received usual care (UC-group). In the HTM-group, weight, heart rate, blood pressure and symptom severity were measured daily.
  
  
  RESULTS
  At referral, respectively 90%, 90%, 67% and 94% of patients with LVEF ≤40% (n = 229) were treated with β-blockers (BB), angiotensin converting enzyme-inhibitors (ACE-I) or angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA) and diuretics, with rates similar between groups. After 6 months, prescription of BB (92% vs 83%), ACE-I/ARB (92% vs 90%) and MRA (68% vs 67%) did not differ significantly between groups. The proportions of patients who achieved ≥50% and ≥100% of target doses of BB, ACE-I/ARB and MRA were also similar in each group. However, during a median follow-up of 1094 days (IQR 767-1419) fewer patients who chose HTM died (33% vs 49%; P = 0.002).
  
  
  CONCLUSIONS
  Patients who choose HTM have a better prognosis than those who do not but this does not appear to be mediated through greater prescription of key HF medications.
authors.affiliation: Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull r.dierckx@hull.ac.uk rietdierckx@hotmail.com.
authors.forename: Riet
authors.initials: R
authors.lastname: Dierckx
authors.affiliation: National Heart & Lung Institute and National Institute of Health Research, Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London.
authors.forename: John Gf
authors.initials: JG
authors.lastname: Cleland
authors.affiliation: Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Pellicori
authors.affiliation: Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull.
authors.forename: Jufen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Faculty of Health and Social Care, University of Hull, Kingston-upon-Hull.
authors.forename: Kevin
authors.initials: K
authors.lastname: Goode
authors.affiliation: Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull.
authors.forename: Paola
authors.initials: P
authors.lastname: Putzu
authors.affiliation: Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull.
authors.forename: Vennela
authors.initials: V
authors.lastname: Boyalla
authors.affiliation: Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017216:Telemedicine
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics
keywords: ehealth; telecardiology; telehealth