title: The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study.
abstract: OBJECTIVE
  It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs.
  
  
  METHODS
  A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL).
  
  
  RESULTS
  In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01).
  
  
  CONCLUSIONS
  ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: i.h.kraai@umcg.nl.
authors.forename: Imke
authors.initials: I
authors.lastname: Kraai
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Arjen
authors.initials: A
authors.lastname: de Vries
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Vermeulen
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: van Deursen
authors.affiliation: Linköping University, Faculty of Health Sciences, Department of Social and Welfare Studies, Linköping, Sweden.
authors.forename: Martje
authors.initials: M
authors.lastname: van der Wal
authors.affiliation: Department of Cardiology, Wilhelmina Hospital Assen, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: de Jong
authors.affiliation: Department of Cardiology, Cavari Clinics Groningen, The Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: van Dijk
authors.affiliation: Linköping University, Faculty of Health Sciences, Department of Social and Welfare Studies, Linköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Hillege
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Ivonne
authors.initials: I
authors.lastname: Lesman
mesh_terms: D000368:Aged; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007256:Information Systems; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017216:Telemedicine
keywords: Computer decision support; Disease management; Heart failure; ICT-guided disease-management; Telemonitoring