Santiago Jiménez-Marrero1,2, Sergi Yun1,2,3, Miguel Cainzos-Achirica1,2,4, Cristina Enjuanes1,2, Alberto Garay1,2, Nuria Farre5,6,7, Jose M Verdú7,8,9, Anna Linas5,6, Pilar Ruiz5,6, Encarnación Hidalgo1,2, Esther Calero1,2,9, Josep Comín-Colet1,2,10. 1. Community Heart Failure Program, Bellvitge University Hospital, Spain. 2. Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain. 3. Department of Internal Medicine, Bellvitge University Hospital, Spain. 4. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, USA. 5. Heart Failure Unit, Hospital del Mar, Spain. 6. Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Biomedical Research Institute (IMIM), Spain. 7. Department of Medicine, Universitat Autònoma de Barcelona, Spain. 8. Sant Martí de Provençals Primary Care Center, Institut Catalá de la Salut, Spain. 9. Primary Care Research Institute Jordi Gol (IDIAP), Spain. 10. Department of Clinical Sciences, University of Barcelona, Spain.
Abstract
Background: The efficacy of telemedicine in the management of patients with chronic heart failure and left ventricular ejection fraction ≥40% is poorly understood. The aim of our analysis was to evaluate the efficacy of a telemedicine-based intervention specifically in these patients, as compared to standard of care alone. Methods: The Insuficiència Cardiaca Optimització Remota (iCOR) study was a single centre, randomised, controlled trial, designed to evaluate a telemedicine intervention added to an existing hospital/primary care multidisciplinary, integrated programme for chronic heart failure patients. 178 participants were randomised to telemedicine or usual care, and were followed for six months. For the present sub-analysis, only iCOR participants (n = 116) with left ventricular ejection fraction ≥40% were included. The primary study endpoint was the incidence of an acute non-fatal heart failure event, defined as a new episode of worsening of symptoms and signs consistent with acute heart failure requiring intravenous diuretic therapy. The healthcare-related costs in each study group were also evaluated. Results: The incidence of the first occurrence of the primary endpoint was significantly lower in the telemedicine arm (22% vs 56%, p<0.001), with a hazard ratio of 0.33 comparing to the usual care arm (95% confidence interval 0.17–0.64). Telemedicine was also associated with lower mean overall chronic heart failure care-related costs compared to usual care (8163€ vs 4993€, p=0.001). The results were consistent in both left ventricular ejection fraction of 40–49% and left ventricular ejection fraction ≥50% patients. Conclusions: Our results suggest that telemedicine is a promising strategy for the management of chronic heart failure patients with left ventricular ejection fraction ≥40%. These findings should be replicated in larger cohorts.
RCT Entities:
Background: The efficacy of telemedicine in the management of patients with chronic heart failure and left ventricular ejection fraction ≥40% is poorly understood. The aim of our analysis was to evaluate the efficacy of a telemedicine-based intervention specifically in these patients, as compared to standard of care alone. Methods: The Insuficiència Cardiaca Optimització Remota (iCOR) study was a single centre, randomised, controlled trial, designed to evaluate a telemedicine intervention added to an existing hospital/primary care multidisciplinary, integrated programme for chronic heart failurepatients. 178 participants were randomised to telemedicine or usual care, and were followed for six months. For the present sub-analysis, only iCOR participants (n = 116) with left ventricular ejection fraction ≥40% were included. The primary study endpoint was the incidence of an acute non-fatal heart failure event, defined as a new episode of worsening of symptoms and signs consistent with acute heart failure requiring intravenous diuretic therapy. The healthcare-related costs in each study group were also evaluated. Results: The incidence of the first occurrence of the primary endpoint was significantly lower in the telemedicine arm (22% vs 56%, p<0.001), with a hazard ratio of 0.33 comparing to the usual care arm (95% confidence interval 0.17–0.64). Telemedicine was also associated with lower mean overall chronic heart failure care-related costs compared to usual care (8163€ vs 4993€, p=0.001). The results were consistent in both left ventricular ejection fraction of 40–49% and left ventricular ejection fraction ≥50% patients. Conclusions: Our results suggest that telemedicine is a promising strategy for the management of chronic heart failurepatients with left ventricular ejection fraction ≥40%. These findings should be replicated in larger cohorts.
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