Baltimore, MD - In an interim analysis of a pilot study, ambulatory patients with heart failure believed their disease was better controlled and may have avoided hospitalizations by using a remote monitoring device to regularly stay in touch with providers, who could observe their vital signs and symptom status and recommend treatment adjustments as needed [1].

The findings, which didn't reach statistical significance in the small study, nonetheless suggest that a telemonitoring strategy as part of a heart-failure disease-management program may benefit patients who aren't limited to staying at home just as, in other studies, it has helped the homebound with heart failure, according to researchers who presented them here at the American Heart Association 2008 Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference.

The patients who used the telemonitoring system after discharge from a heart-failure hospitalization had fewer all-cause and heart-failure rehospitalizations over the next three months compared with similar patients who received standard care. The six-month data, which will be reported at a future meeting and submitted for publication, "is even more optimistic about how the telemonitoring is working," although they didn't achieve significance either, according to Dr Ambar Kulshreshtha (Massachusetts General Hospital, Boston), who led the study. Still, he told heartwire, the trends seen at three months were strengthened in the six-month analysis.

Those trends appear consistent with earlier studies of telemonitoring, generally used as part of a heart-failure disease-management program, that have been covered by heartwire. Often, they have suggested that remote telemonitoring, possibly by promoting earlier treatment interventions as needed, may reduce patients' risks of hospitalization and death, although the effects have not always been significant.

There have also been suggestions in the earlier studies that remote monitoring may make the most clinical difference for patients with the severest disease. Kulshreshtha and his colleagues say their findings were nonsignificant probably at least in part because ambulatory patients have fewer events than homebound patients, and longer follow-up is needed to show an effect from interventions.

Of 150 eligible patients, 68 were randomized to a usual-care control group and 82 to remote monitoring as part of the Harvard-affiliated Connected Cardiac Care Program (CCCP); of the 82, 42 patients or their physicians declined to participate, leaving 40 in the telemonitoring intervention group. Those who declined also received usual care, according to Kulshreshtha.

The monitoring device (Turtle 400, Vitel Net) transmitted data on patients' weight, pulse, blood pressure, and symptom status (based on questions answered by the patient) to nurses, who could, with physician oversight, manage any adjustments to therapy.

Kulshreshtha said the findings are helping CCCP physicians identify and address what seem to be potential barriers to acceptance of telemonitoring as a management strategy. For example, many of the patients who refused participation said it was because they were "uncomfortable" with the technology or because they were planning travel away from home during the study period or otherwise found it "hard to fit into their schedules."

The primary-care doctors who declined to participate, he said, often cited reimbursement concerns: "How am I going to be compensated for my time when there are all these data coming in?" Kulshreshtha said he tries to explain that the telemonitoring nurse receives the patient information and contacts the physician only as necessary. "So there's really no increase in the physician's workload."

And patients using the telemonitoring system generally report they feel more connected with the nurses and their doctor, according to Kulshreshtha, and "like it more than they expected to." In surveys of the patients, virtually all reported "a high level of satisfaction" and a sense of "improved heart-failure control," with the device helping to keep them out of the hospital.