The value of innovative ICT guided disease management combined with telemonitoring in outpatient clinics for chronic heart failure patients -IN TOUCH-

Abstract

Purpose: Chronic heart failure is a rapidly increasing epidemic with high mortality and morbidity, reduced quality of life, and increasing costs for the society. Although guidelines for the management of heart failure are clear, the quality of care - especially up titration of medication - can still be improved. Furthermore, costs need to be controlled. Disease management is a factor which can improve quality of care and this might be further improved using software programmes (ICT-guided disease management). Disease management combined with telemedicine makes it possible to distantly monitor a patient and it is therefore expected to improve the quality of care and to reduce costs. The aim of this study is to investigate the effect of ICT guided disease management (DM) and telemedicine (TM) on the quality and efficiency of care in patients with heart failure after hospitalization. Methods: The study is divided in three arms; a control arm with care as usual (CAU) in 10 hospitals and two randomized intervention arms (DM en DM+TM) in 10 other hospitals in the Netherlands. In total 450 patients will be included after a hospitalization for heart failure (CAU: N=225, DM: N=75, DM+TM: N=150). An ICT guided disease management system containing the European Heart Failure guidelines will be used in the intervention arms. This software programme uses the guideline parameters to produce an advice about optimal therapy. Patients in the DM+TM group will additionally be provided with TM devices (scale, ECG device, health monitor and blood pressure meter) that directly feed the results into the DM. Patients will be instructed to weigh and perform a blood pressure measurement daily. Patients requiring up titration of beta blockers receive an ECG device for biweekly assessment of heart rhythm until optimal dosage is established. The DM generates SMS text messages and e-mail alarms for the clinicians if values of the TM devices are outside preset ranges. Follow-up will be 9 months. Primary endpoint of the study is a composite score of: 1. death from any cause during the follow-up of the study, 2. first readmission for heart failure and 3. change in quality of life compared to baseline, assessed by the Minnesota Living with Heart failure Questionnaire. An important secondary endpoint is cost-effectiveness. Results: The study has started in December 2009. Results are expected in 2012. Conclusion: The IN TOUCH study is the first to investigate the effect of an ICT guided disease management system in combination with telemedicine on the quality and efficiency of care in patients after a hospitalization for heart failure.