SPC365

Long-term benefits of non-invasive telemonitoring in patients with chronic heart failure

Session: Comunicações Orais (Sessão 10) - Insuficiência Cardíaca 1 - Parâmetros de Avaliação e Prognóstico
Speaker: Catarina Gregório

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.7 Chronic Heart Failure - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Gregório; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Oliveira; João Santos Fonseca; Ana Abrantes; Afonso Nunes Ferreira; João Agostinho; Fausto j. Pinto; Dulce Brito

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The impact on prognosis and quality of life of non-invasive remote monitoring (TM) of patients with heart failure (HF) is controversial. In addition, studies evaluating the results of TM in long-term follow-up are scarce.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To assess in chronic HF patients the 36-month efficacy of a TM program vs usual care (UC) vs a protocol-based follow-up program (PFP) but with no TM facilities.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Prospective and single center study of propensity score matched patients discharged from hospital after an episode of decompensated HF. Patients were matched according to age, NYHA at discharge and ejection fraction (EF), and three groups were considered: 50 integrated a PFP after hospital discharge; 50 were followed according to&nbsp; UC; and 25 integrated a TM program. This last group included only patients &ge; 1 HF hospitalization in the previous year included in the program. These patients were evaluated remotely 24/7. The 36-month TM program efficacy was assessed by composite endpoint of death or HF hospitalization (Kaplan-Meier analysis). Secondary endpoints included the number of days lost due to unplanned hospital admission, evaluated by hospital emergency department admission, days of hospitalization or death -analysed by T-student test.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Mean age of patients was 66.8&plusmn;10.6 years, 28% female. Dilated cardiomyopathy was the main aetiology (53.3%). All patients had a reduced EF (HFrEF), median EF baseline was 26% and NTproBNP was 3293&plusmn;3542pg/mL. There were no significant differences in the baseline clinical and laboratory characteristics of patients. In the 36-month efficacy evaluation, there was a reduction in the composite endpoint of death or HF hospitalization between TM and UC (28% vs 66%;HR 0.54 95%CI 0.36-0.82,p&lt;0.01); TM was similar to PFP (HR 0.63,p=0.28). These TM prognostic benefits were mainly driven by a reduction in all-cause death compared to UC (12% vs 34%,LogRank 3.98,p=0.046). TM was similar to PFP regarding all-cause death (12% vs 20%,HR 0.58,p=0.41) and HF hospitalization (28% vs 32%,HR 0.85,p=0.72).&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">There was a reduction in the average number of days lost due to unplanned hospital admissions or all-cause death in the TM group compared to UC (61.9vs186.4 days,p&lt;0.01) and PFP (61.9 vs 112.2 days,p&lt;0.01).</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the long-term follow-up of severe HFrEF patients, non-invasive TM facilities may have prognostic benefit when compared to UC, and significantly reduces unplanned hospital admission compared to both UC and PFP.</span></span></span></p>