Clinical and Psycological Telemonitoring and Telecare of High Risk Patientswith Chronic Heart Failure through Wireless Technologies: The Icaros Project

Background: Disease management is mandatory for the home care of most patients with chronic heart failure. We report the results of ICAROS (Integrated care vs Conventional intervention in cArdiac failure patients: Randomized Open label Study), an Italian trial of telemonitoring and telecare combining wireless and mobile technologies to obtain optimal therapeutic control, fast and effective interpretation of clinical data and improved patients’ adherence.Methods: Eighty patients were randomized before hospital discharge after an episode of acute heart failure, to a usual care group (UC) (n=40: follow-up at our Outpatients’ clinic) or to an integrated management group (IM) (n=40: patients learned to use a PDA computer and kept in touch daily with our Centre to receive instructions, encouragement, clinical and psychological assistance. Results: At enrolment, groups were similar for age (UC 73 ± 3 years; IM 71 ± 2 years); NYHA class (UC 2.90 ± 0.69; IM 3.08 ± 0.57), left ventricular function (EF%) (UC 32 ± 8%; IM 32 ± 7%), plasma levels of BNP (UC 361 ± 72 pg/ml; IM 314 ± 94 pg/ml). At one-year follow-up, IM patients showed better adherence, reduction of anxiety and depression and lower NYHA class and plasma levels of BNP with respect to UC patients (NYHA: 2.08 ± 0.38; BNP: 202 ± 127 pg/ml, p<0.05 vs UC patients). Mortality and hospital re-admissions for congestive heart failure were also reduced in IM patients (p<0.05).Conclusions: In ICAROS, regular acquisition by wireless technologies of clinical and psychological data provided a good model for clinical decision-making, determining better quality of life and reducing mortality and hospitalizations.