The
Cardiomyopathy
Association

The home monitoring of patients with heart problems has achieved significant improvements in survival and risk of hospital re-admission for heart failure, say researchers in Australia.

They looked at  two common telemonitoring strategies – phone calls with a nurse and automatic monitoring and data transmission with specialised devices.

The analysis included 25 published heart failure telemonitoring studies involving 8,323 patients: 16 trials of structured telephone support and 11 of complex device-oriented telemonitoring (compared with "usual care" and including two studies that involved both forms of telemonitoring). Patients were not receiving regular home visits by heart failure specialist nurses in any of the studies.

But there were some mixed results and patients with different preferences. It may be that both methods have strengths and weaknesses in different types of patients or care-delivery settings, and both can be used by the same clinic, Dr Robyn Clark from the Queensland University of Technology, Brisbane told the Heart Failure Society of America’s recent scientific meeting.

She said: "It could be that simple telephone calls and complex telemonitoring with specialised equipment are used by the same heart failure clinic at different times in the patient's disease," she speculated for the online news website heartwire.

"A phone call could be best at the early stages when patients are getting their heads around what's happening to them and how they need to manage themselves," she said. “Complex telemonitoring, which involves the least participation by the patient, could be more suited to people with regular admissions or who are very fragile."

Standing out in the analysis was a third variation on telemonitoring—interactive voice recognition — whereby patients called in to access an automated question-response menu tree. Patients responded to questions about their status and replied by pressing phone buttons (for example: please enter your weight in pounds then press the pound sign or have you taken your medications today? Press 1 for yes and 2 for no). Not only was that unpopular, Dr Clark said, it seemed to have no effect on outcomes.

The phone call was most often preferred. Explanations could include that the current age group with most heart failure was more comfortable with human contact and less enthusiastic about complex monitoring. Dr Clark said that if it was the latter, that situation would not last much longer. She said: “The baby boomers won't be that way at all. They're already online and using mobile phones."

Phone calls have special advantages, anyway, she noted. "Speaking to a heart failure patient on the telephone is a highly sensitive way of measuring their current breathlessness. You can't talk on the phone well if you're breathless. So we can tell how they're doing from day to day."