Impact on clinical events and healthcare costs of adding telemedicine to multidisciplinary disease management programmes for heart failure: Results of a randomized controlled trial.
BACKGROUND
The role of telemedicine in the management of patients with chronic heart failure (HF) has not been fully elucidated. We hypothesized that multidisciplinary comprehensive HF care could achieve better results when it is delivered using telemedicine.


RESULTS
In this study, 178 eligible patients with HF were randomized to either structured follow-up on the basis of face-to-face encounters (control group, 97 patients) or delivering health care using telemedicine (81 patients). Telemedicine included daily signs and symptoms based on telemonitoring and structured follow-up by means of video or audio-conference. The primary end-point was non-fatal HF events after six months of follow-up. The median age of the patients was 77 years, 41% were female, and 25% were frail patients. The hazard ratio for the primary end-point was 0.35 (95% confidence interval (CI), 0.20-0.59; p-value < 0.001) in favour of telemedicine. HF readmission (hazard ratio 0.39 (0.19-0.77); p-value=0.007) and cardiovascular readmission (hazard ratio 0.43 (0.23-0.80); p-value=0.008) were also reduced in the telemedicine group. Mortality was similar in both groups (telemedicine: 6.2% vs control: 12.4%, p-value > 0.05). The telemedicine group experienced a significant mean net reduction in direct hospital costs of €3546 per patient per six months of follow-up.


CONCLUSIONS
Among patients managed in the setting of a comprehensive HF programme, the addition of telemedicine may result in better outcomes and reduction of costs.
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Spain josepcomin@gmail.com.
Josep
J
Comín-Colet
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Spain.
Cristina
C
Enjuanes
Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Spain Jordi Gol Primary Care Research Institute, Catalan Institute of Health, Spain.
José M
JM
Verdú-Rotellar
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Anna
A
Linas
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Pilar
P
Ruiz-Rodriguez
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Gina
G
González-Robledo
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Núria
N
Farré
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Pedro
P
Moliner-Borja
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Sonia
S
Ruiz-Bustillo
Department of Cardiology, Hospital del Mar, Barcelona, Spain Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Jordi
J
Bruguera
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D020377:Self Efficacy; D017216:Telemedicine / Q000379:methods*
Outcomes research; chronic care model; disease management; heart failure; telemedicine