1. The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study
- Author
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Trijntje Jaarsma, Richard M. de Jong, Hans L. Hillege, I. H. Kraai, Rene B. van Dijk, Vincent M. van Deursen, Karin M. Vermeulen, Martje H. L. van der Wal, Arjen E. de Vries, Ivonne Lesman, Methods in Medicines evaluation & Outcomes research (M2O), Value, Affordability and Sustainability (VALUE), Life Course Epidemiology (LCE), Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)
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Male ,Sociologi ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Sociology ,Randomized controlled trial ,Quality of life ,DESIGN ,PROGRAMS ,law ,Disease management ,Outpatient clinic ,030212 general & internal medicine ,Disease management (health) ,Ejection fraction ,Middle Aged ,Telemedicine ,EUROPEAN-SOCIETY ,TRIALS ,Female ,HEALTH ,Information Systems ,INTERVENTIONS ,medicine.medical_specialty ,Telemonitoring ,Heart failure ,Health Informatics ,03 medical and health sciences ,New York Heart Association Classification ,Internal medicine ,parasitic diseases ,medicine ,Humans ,ICT-guided disease-management ,Heart failureDisease managementTelemonitoringICT-guided disease-managementComputer decision support ,Aged ,Monitoring, Physiologic ,business.industry ,fungi ,AMBULATORY PATIENTS ,Mean age ,CARE ,medicine.disease ,ICT-guided disease management ,Physical therapy ,Computer decision support ,business ,METHODOLOGY ,DECISION-SUPPORT-SYSTEMS - Abstract
Aim: It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. Methods: A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS + telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). Results: In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS + telemonitoring (mean difference 0.1,95% CI: -0.67 +0.82, p = 0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS + telemonitoring (p = 0.27); HF-readmission 28% vs. 27% p = 0.87; all-cause readmission was 49% vs. 51% (p = 0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were 1360 in favor of ICT-guided-DMS. ICT-guided-DMS + telemonitoring had significantly fewer HF-outpatient-clinic visits (p < 0.01). Conclusion: ICT-guided-DMS + telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://cleativecommons.org/licenses/by-nc-nd/4.0/). Funding Agencies|Dutch Ministry of Health, Department of Pharmaceutical Affairs and Medical Technology (GMT)
- Published
- 2016
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