Spironolactone Metabolites in TOPCAT — New Insights into Regional Variation

Abstract

To the Editor: In their article on the Telemonitor-ing to Improve Heart Failure Outcomes (Tele-HF) trial (ClinicalTrials.gov number, NCT00303212), Chaudhry et al. (Dec. 9 issue) 1 report neutral ef-fectiveness of remote telemonitoring in patients with heart failure, in contrast to the results of a previous meta-analysis. 2 Most studies have fo-cused on patient-reported data. The risk is infor-mation overload for and noncompliance by health care professionals. In the present study, 14% of the patients did not use the intervention, and 45% of the patients did not adhere to the intervention. The World Health Organization 3 has identified patient-centered care 4 as a core component in quality health care in the 21st century, and we suggest that patient-centered care will increase the effectiveness of telemonitoring. Telemonitoring needs to focus on patients' self-care instead of reporting data. 5 Given the progressive nature of chronic heart failure and the need for extensive management of the illness, it is important that professionals and patients develop a partnership to achieve commonly agreed-on goals. How was this partnership achieved in the Tele-HF study? We suggest that modern mobile-phone technol-ogy can advance person-centered telemonitoring.