Telemedical Support in Patients with Chronic Heart Failure: Experience from Different Projects in Germany

The great epidemiological significance and costs associated with chronic heart failure pose a challenge to health systems in Western industrial countries. In the past few years, controlled randomised studies have shown that patients with chronic heart failure benefit from telemedical monitoring; specifically, telemonitoring of various vital parameters combined with a review of the symptoms, drug compliance and patient education. In Germany, various telemedical monitoring projects for patients with chronic heart failure have been initiated in the past few years; seven of them are presented here. Currently 7220 patients are being monitored in the seven selected projects. Most patients (51.1%) are in NYHA stage II, 26.3% in NYHA stage III, 14.5% in NYHA stage I and only 6.6% in NYHA stage IV respectively. Most projects are primarily regional. Their structure of telemedical monitoring tends to be modular and uses stratification according to the NYHA stages. All projects include medical or health economics assessments. The future of telemedical monitoring projects for patients with chronic heart failure will depend on the outcome of these assessments. Only of there is statistical evidence for medical benefit to the individual patient as well as cost savings will these projects continue.

[1]  S. Lücke,et al.  Partnership for the Heart -Entwicklung und Erprobung eines neuen telemedizinischen Monitoring-Systems : Projekt des Innovationsprogramms ,,next generation media des BMWi , 2007 .

[2]  W G Stevenson,et al.  Prognostic Significance of Atrial Fibrillation in Advanced Heart Failure: A Study of 390 Patients , 1991, Circulation.

[3]  R. Erbel,et al.  Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspectives. , 2009, Deutsches Arzteblatt international.

[4]  Salim Yusuf,et al.  Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta‐analysis , 2005, European journal of heart failure.

[5]  V. Hasselblad,et al.  Metaanalysis and review of heart failure disease management randomized controlled clinical trials. , 2005, American heart journal.

[6]  V. Preedy,et al.  Prospective Cohort Study , 2010 .

[7]  S Capewell,et al.  More ‘malignant’ than cancer? Five‐year survival following a first admission for heart failure , 2001, European journal of heart failure.

[8]  Simon Stewart,et al.  Financial aspects of heart failure programs of care , 2005, European journal of heart failure.

[9]  L. A. Bonet,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2012, Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir.

[10]  T. Helms,et al.  Telemedizinische Betreuung chronisch herzinsuffizienter Patienten am Beispiel des telemedizinischen Patientenbetreuungs- und -schulungsprogramms „Telemedizin fürs Herz“ , 2007, Herz Kardiovaskuläre Erkrankungen.

[11]  L. A. Bonet,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2010, European journal of heart failure.

[12]  K. Swedberg,et al.  Weight changes after hospitalization for worsening heart failure and subsequent re-hospitalization and mortality in the EVEREST trial. , 2009, European heart journal.

[13]  W. Stevenson,et al.  Improving survival for patients with advanced heart failure: a study of 737 consecutive patients. , 1995, Journal of the American College of Cardiology.

[14]  A. Louis,et al.  A systematic review of telemonitoring for the management of heart failure , 2003, European journal of heart failure.

[15]  R. Cody,et al.  Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure , 2005, Circulation.

[16]  M. Schieber,et al.  ["Partnership for the Heart"--development and testing of a new remote patient monitoring system]. , 2007, Deutsche medizinische Wochenschrift.

[17]  Klaus Kleinfeld,et al.  Partnership for the heart. German-Estonian health project for the treatment of congenital heart defects in Estonia. , 2005, Health policy.

[18]  M. Oeff,et al.  Überwachung multipler Herzkreislaufparameter mittels Telemonitoring bei Patienten mit chronischer Herzinsuffizienz , 2005, Herzschrittmachertherapie & Elektrophysiologie.

[19]  J. Cleland,et al.  Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis , 2007, BMJ : British Medical Journal.

[20]  I Harvey,et al.  Systematic review of multidisciplinary interventions in heart failure , 2005, Heart.

[21]  Tiny Jaarsma,et al.  Compliance in heart failure patients: the importance of knowledge and beliefs. , 2006, European heart journal.

[22]  M. Middeke,et al.  Einfluss einer telemedizinisch unterstützten Betreuung auf Gesamtbehandlungskosten und Mortalität bei chronischer Herzinsuffizienz , 2007 .

[23]  C. Angermann,et al.  Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community‐based sample of patients with chronic heart failure A prospective cohort study , 2008, European journal of heart failure.

[24]  M. Walsh,et al.  Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. , 2003, American heart journal.

[25]  F.E.S.C. Prof. Dr. med. S. Silber F.A.C.C. Argumente für die Integrierte Versorgung als Regelversorgung in der Kardiologie , 2006, Clinical Research in Cardiology.

[26]  A. Rigby,et al.  Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. , 2005, Journal of the American College of Cardiology.

[27]  L. Tavazzi,et al.  Precipitating factors and decision-making processes of short-term worsening heart failure despite "optimal" treatment (from the IN-CHF Registry). , 2001, The American journal of cardiology.

[28]  Stephen Morris,et al.  A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home‐HF study , 2009, European journal of heart failure.

[29]  T. Neumann,et al.  Heart Failure: the Commonest Reason for Hospitalization in Germany—Medical and Economic Perspectives: In reply , 2009 .

[30]  J. Mullooly,et al.  Changing Incidence and Survival for Heart Failure in a Well-Defined Older Population, 1970–1974 and 1990–1994 , 2006, Circulation.

[31]  Piotr Ponikowski,et al.  Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure) , 2009, European journal of heart failure.

[32]  Perry M. Elliott,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2010, European journal of heart failure.

[33]  P. Hanrath,et al.  Leitlinien zur Therapie der chronischen Herzinsuffizienz , 2005, Zeitschrift für Kardiologie.

[34]  N. Freemantle,et al.  Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey , 2002, The Lancet.

[35]  Kazufumi Nakamura,et al.  Guidelines for treatment of chronic heart failure , 2012 .

[36]  Michal Golovner,et al.  Telecardiology for patients with chronic heart failure: the 'SHL' experience in Israel. , 2004, International journal of cardiology.