G Poelzl1, T Egelseer-Bruendl2, B Pfeifer3, R Modre-Osprian4, S Welte4, B Fetz3, S Krestan3, B Haselwanter3, M M Zaruba2, J Doerler2, C Rissbacher5, E Ammenwerth6, A Bauer2. 1. Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. Gerhard.poelzl@tirol-kliniken.at. 2. Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. 3. Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria. 4. Center for Health and Bioresources, AIT Austrian Institute of Technology, Graz, Austria. 5. University Hospital Innsbruck, TirolKliniken, Innsbruck, Austria. 6. Institute of Medical Informatics, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
Abstract
AIMS: It remains unclear whether transitional care management outside of a clinical trial setting provides benefits for patients with acute heart failure (AHF) after hospitalization. We evaluated the feasibility and effectiveness of a multidimensional post-discharge disease management programme using a telemedical monitoring system incorporated in a comprehensive network of heart failure nurses, resident physicians, and secondary and tertiary referral centres (HerzMobil Tirol, HMT), METHODS AND RESULTS: The non-randomized study included 508 AHF patients that were managed in HMT (n = 251) or contemporaneously in usual care (UC, n = 257) after discharge from hospital from 2016 to 2019. Groups were retrospectively matched for age and sex. The primary endpoint was time to HF readmission and all-cause mortality within 6 months. Multivariable Cox proportional hazard models were used to assess the effectiveness. The primary endpoint occurred in 48 patients (19.1%) in HMT and 89 (34.6%) in UC. Compared with UC, management by HMT was associated with a 46%-reduction in the primary endpoint (adjusted HR 0.54; 95% CI 0.37-0.77; P < 0.001). Subgroup analyses revealed consistent effectiveness. The composite of recurrent HF hospitalization and death within 6 months per 100 patient-years was 64.2 in HMT and 108.2 in UC (adjusted HR 0.41; 95% CI 0.29-0.55; P < 0.001 with death considered as a competing risk). After 1 year, 25 (10%) patients died in HMT compared with 66 (25.7%) in UC (HR 0.38; 95% CI 0.23-0.61, P < 0.001). CONCLUSIONS: A multidimensional post-discharge disease management programme, comprising a telemedical monitoring system incorporated in a comprehensive network of specialized heart failure nurses and resident physicians, is feasible and effective in clinical practice.
AIMS: It remains unclear whether transitional care management outside of a clinical trial setting provides benefits for patients with acute heart failure (AHF) after hospitalization. We evaluated the feasibility and effectiveness of a multidimensional post-discharge disease management programme using a telemedical monitoring system incorporated in a comprehensive network of heart failure nurses, resident physicians, and secondary and tertiary referral centres (HerzMobil Tirol, HMT), METHODS AND RESULTS: The non-randomized study included 508 AHF patients that were managed in HMT (n = 251) or contemporaneously in usual care (UC, n = 257) after discharge from hospital from 2016 to 2019. Groups were retrospectively matched for age and sex. The primary endpoint was time to HF readmission and all-cause mortality within 6 months. Multivariable Cox proportional hazard models were used to assess the effectiveness. The primary endpoint occurred in 48 patients (19.1%) in HMT and 89 (34.6%) in UC. Compared with UC, management by HMT was associated with a 46%-reduction in the primary endpoint (adjusted HR 0.54; 95% CI 0.37-0.77; P < 0.001). Subgroup analyses revealed consistent effectiveness. The composite of recurrent HF hospitalization and death within 6 months per 100 patient-years was 64.2 in HMT and 108.2 in UC (adjusted HR 0.41; 95% CI 0.29-0.55; P < 0.001 with death considered as a competing risk). After 1 year, 25 (10%) patients died in HMT compared with 66 (25.7%) in UC (HR 0.38; 95% CI 0.23-0.61, P < 0.001). CONCLUSIONS: A multidimensional post-discharge disease management programme, comprising a telemedical monitoring system incorporated in a comprehensive network of specialized heart failure nurses and resident physicians, is feasible and effective in clinical practice.
Authors: Robert Modre-Osprian; Katharina Gruber; Karl Kreiner; Guenter Schreier; Gerhard Poelzl; Peter Kastner Journal: Stud Health Technol Inform Date: 2015
Authors: Alphons Eggerth; Robert Modre-Osprian; Dieter Hayn; Peter Kastner; Gerhard Pölzl; Günter Schreier Journal: Stud Health Technol Inform Date: 2017
Authors: Alphons Eggerth; Karl Kreiner; Dieter Hayn; Bernhard Pfeifer; Gerhard Pölzl; Tim Egelseer-Bründl; Günter Schreier Journal: Stud Health Technol Inform Date: 2020-06-16
Authors: Aaron Lauschensky; Dieter Hayn; Alphons Eggerth; Robert Modre-Osprian; Bernhard Pfeifer; Tim Egelseer-Bründl; Gerhard Pölzl; Günter Schreier Journal: Stud Health Technol Inform Date: 2020-06-23