Evaluation of the efficacy and costs impact of a telemonitoring and teleintervention trough videoconference program for patients with chronic heart failure: a randomized controlled trial

Abstract

Background: While telemonitoring has not shown clear benefits, heart failure (HF) management programs had. It is unknown whether a management program based on telemedicine provides advantages compared to conventional management on a HF program. Objectives: Evaluate efficacy and costs benefits of a HF management program using telemedicine compared to standard HF management program. Methods: Prospective, randomized, controlled trial comparing two management strategies of high risk HF patients: HFP (heart failure programme) or HFP + T (heart failure programme based on telemedicine). Telemedicine management consisted in daily telemonitoring of weight, blood pressure, heart rate and symptoms that were transmitted to a central station controlled by HF nurses. Teleintervention was carried out replacing the physical appointments by videoconference, promoting self-care and performing therapeutic optimization. The determination of direct costs was performed using cost accounting methodology. Primary end-point: non-fatal HF events by requiring hospital attention at 6 months of inclusion (decompensations requiring parenteral treatment). Results: a preliminary analysis of the first 74 patients included was performed. Baseline characteristics: mean age was 77 years 46, 2% were women, 51.3% had preserved LVEF, 50% were in NYHA class III-IV. From 74 patients, 37 were assigned to HFP and 41 to HFP + T. After a follow-up of 6 months, HFP + T group experienced a significant reduction in the primary endpoint and a favorable trends in morbidity and mortality. HF non-fatal event rate, HF readmission rate and mortality rates were 22%(p:0.007), 14.6%(p:0.09) and 9.8% (p:0.39) respectively. In Cox analysis adjusted for covariates, HFP + T group assignment was a risk reduction of the combined endpoint (all-cause death or HF nonfatal events) (HR 0.36 95% CI [0.17 to 0, 76], P=0.008). Total direct cost of the cohort studied was E 666,829 (8,863 per patient+E 1,423). The average cost per patient was significantly lower in the HFP + T group compared with HFP group (4.350(plus or minus)1.257E vs. 13.625(plus or minus)2.378E; p<0.001) with a mean difference per patient between the two groups of 9274+E 2,650. Conclusions: Addition of telemedicine to a HF program means: (1) a significant reduction in the number and rate of HF-nonfatal events and also risk reduction of the combined endpoint (all-cause death or HF nonfatal event) with a positive trend in terms of morbidity and mortality. (2) a significant reduction of health costs. The magnitude of the observed reduction suggests their implementation is cost-effective with a quick return in economic terms.