title: Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey.
abstract: BACKGROUND
  Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries.
  
  
  OBJECTIVE
  We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden.
  
  
  METHODS
  This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring.
  
  
  RESULTS
  The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6%, 82/378; in Sweden: 30.0%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1%, 352/374) and Sweden (88.7%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9%, 100/115) and to do remote drug titration (79.1%, 91/115). Just under a quarter of Japanese (22.4%, 85/378) and over a third of Swedish (38.1%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers "how are we going to do it?" (categories include structure and resource), health care professionals themselves "what do we need to know and do" (reservation), and barriers related to patients "not everybody would benefit" (internal and external shortcomings).
  
  
  CONCLUSIONS
  Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients' hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring.
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden. naoko.kato@liu.se.
authors.forename: Naoko P
authors.identifier: http://orcid.org/0000-0002-4437-0260
authors.initials: NP
authors.lastname: Kato
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0001-7431-2873
authors.initials: P
authors.lastname: Johansson
authors.forename: Ikuko
authors.identifier: http://orcid.org/0000-0002-0805-851X
authors.initials: I
authors.lastname: Okada
authors.forename: Arjen E
authors.identifier: http://orcid.org/0000-0001-7644-137X
authors.initials: AE
authors.lastname: de Vries
authors.forename: Koichiro
authors.identifier: http://orcid.org/0000-0003-0009-8477
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0002-4259-3671
authors.initials: A
authors.lastname: Strömberg
authors.forename: Tiny
authors.identifier: http://orcid.org/0000-0002-4197-4026
authors.initials: T
authors.lastname: Jaarsma
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013548:Sweden; D013686:Telemetry / Q000379:methods*
keywords: disease management; expectation; heart failure; implementation barriers; nurses; perception; physicians; telemedicine