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Curso de Atualização em Medicina Cardiovascular 2019
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07. Syncope and Bradycardia
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Clinical impact of non-invasive telemonitoring in patients with chronic heart failure
Session:
CO5 - Insuficiência Cardíaca
Speaker:
Afonso Nunes Ferreira
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.5 Chronic Heart Failure – Prevention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Nunes Ferreira; João Pedro Ribeiro Agostinho; Joana Rigueira; Inês Aguiar Ricardo; Rafael Santos; Tiago Graça Rodrigues; Nelson P. Cunha; Pedro Silvério António; Fátima Veiga; Maria Mónica Mendes Pedro; Fausto José Pinto; Dulce Brito
Abstract
<p><strong>Introduction:</strong></p> <p>Non-invasive remote monitoring of patients with heart failure (HF) may be useful in the early detection of signs and symptoms of decompensation, allowing therapeutic optimization and avoiding rehospitalization.</p> <p> </p> <p><strong>Objectives</strong>:<br /> To assess the efficacy of telemonitoring (TM) integrated in a protocol-based follow-up program (PFP) of patients with HF.</p> <p> </p> <p><strong>Métodos</strong>:</p> <p>Prospective and single center study of patients (pts) discharged from hospital after an episode of decompensated HF, with nested-case control design. Three groups of pts were considered: a group of 50 pts integrated in a PFP after hospital discharge, another group of 22 pts who integrated the PFP together with a telemonitoring program (TM), and a control group of 50 pts who were discharged before the PFP had been put into practice. Pts in the 3 groups were matched according to age, NYHA at discharge and ejection fraction (EF).</p> <p>The TM group included only patients with HF and reduced EF plus ≥1 HF hospitalization in the last year. In these pts, biodata were evaluated remotely and generated clinical alerts whenever altered in relation to the limits defined for each patient, with evaluation by the clinical team 24/7. TM success was assessed by primary outcome (death or hospitalization) at 12 months, using Cox regression and Kaplan-Meier survival analysis.</p> <p> </p> <p><strong>Results</strong>:</p> <p>Patients included concomitantly in PFP and TM were 66 ± 9 years-old, 72% were male, median EF 26% (IQR 20-31), median NTproBNP 2123 pg/mL (IQR 592-4757), 82% were in NYHA II or III, 55% had dilated cardiomyopathy, and the median follow-up time was 244 days (IQR 216-361).</p> <p>During the TM program, alerts were generated mainly because of changes in heart rate and systolic blood pressure. However, only in 3% were clinical alerts confirmed. During the program there has been a significant reduction in technical alerts per patient, which were due to difficulties in the measurement or in transmission of the biodata, demonstrating a learning process of the patients, and also decreasing the team workload.</p> <p>At 12-months of follow-up, a higher success rate regarding the primary outcome was observed in the TM group vs. the control group (86% vs. 32%, HR 0.17, 95% CI 0.05-0.56, p= 0.001), with a relative risk reduction (RRR) of 83%. This reduction was superior to that demonstrated with the PFP alone (72% vs. 32%, HR 0.36 95% CI 0.19-0.67, p= 0.001), which presented RRR of 64%. Similar results were found in rehospitalization for HF (Log Rank p=0.016), all-cause rehospitalization (Log Rank 0=0.016) and death (Log Rank p<0.01).</p> <p> </p> <p><strong>Conclusions</strong>:</p> <p>When integrated into a structured clinical follow-up program, TM is associated with a marked reduction in mortality, readmissions for HF, and rehospitalization for any cause, compared to usual follow-up.</p> <p>This study further suggests that the addition of a TM program to a protocol-based follow-up program of pts with HF can improve results already considered optimized.</p>
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