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Emily Seto - One of the best experts on this subject based on the ideXlab platform.
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exploring the use of Telemonitoring for patients at high risk for hypertensive disorders of pregnancy in the antepartum and postpartum periods scoping review
Jmir mhealth and uhealth, 2020Co-Authors: Emily Seto, Maria Aquino, Sarah E P Munce, Janessa Griffith, Maureen Pakosh, Mikayla MunneryAbstract:Background High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for Telemonitoring interventions. Objective The aim of this study was to explore the use of Telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of Telemonitoring interventions for the management of patients at high risk for HDP? Methods A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the Telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention's design and process of implementation varied. Overall, Telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the Telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions Although current evidence suggests that Telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of Telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for Telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of Telemonitoring interventions.
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self management and clinical decision support for patients with complex chronic conditions through the use of smartphone based Telemonitoring randomized controlled trial protocol
JMIR Research Protocols, 2017Co-Authors: Emily Seto, Joseph A Cafazzo, Patrick Ware, Alexander G Logan, Kenneth R Chapman, Phillip Segal, Heather J RossAbstract:Background: The rising prevalence of chronic illnesses hinders the sustainability of the health care system because of the high cost of frequent hospitalizations of patients with complex chronic conditions. Clinical trials have demonstrated that Telemonitoring can improve health outcomes, but they have generally been limited to single conditions such as diabetes, hypertension, or heart failure. Few studies have examined the impact of Telemonitoring on complex patients with multiple chronic conditions, although these patients may benefit the most from this technology. Objective: The aim of this study is to investigate the impact of a smartphone-based Telemonitoring system on the clinical care and health outcomes of complex patients across several chronic conditions. Methods: A mixed-methods, 6-month randomized controlled trial (RCT) of a smartphone-based Telemonitoring system is being conducted in specialty clinics. The study will include patients who have been diagnosed with one or more of any of the following conditions: heart failure, chronic obstructive pulmonary disease, chronic kidney disease, uncontrolled hypertension, or insulin-requiring diabetes. The primary outcome will be the health status of patients as measured with SF-36. Patients will be randomly assigned to either the control group receiving usual care (n=73) or the group using the smartphone-based Telemonitoring system in addition to usual care (n=73). Results: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by the fall of 2018. Conclusions: This RCT will be among the first trials to provide evidence of the impact of Telemonitoring on costs and health outcomes of complex patients who may have multiple chronic conditions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 41238563; http://www.isrctn.com/ISRCTN41238563 (Archived by WebCite at http://www.webcitation.org/6ug2Sk0af) and Clinicaltrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 (Archived by WebCite at http://www.webcitation.org/6uvjNosBC) [JMIR Res Protoc 2017;6(11):e229]
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developing healthcare rule based expert systems case study of a heart failure Telemonitoring system
International Journal of Medical Informatics, 2012Co-Authors: Emily Seto, Kevin J Leonard, Joseph A Cafazzo, Jan Barnsley, Caterina Masino, Heather J RossAbstract:Abstract Background The use of expert systems to generate automated alerts and patient instructions based on Telemonitoring data could enable increased self-care and improve clinical management. However, of great importance is the development of the rule set to ensure safe and clinically relevant alerts and instructions are sent. The purpose of this work was to develop a rule-based expert system for a heart failure mobile phone-based Telemonitoring system, to evaluate the expert system, and to generalize the lessons learned from the development process for use in other healthcare applications. Methods Semi-structured interviews were conducted with 10 heart failure clinicians to inform the development of a draft heart failure rule set for alerts and patient instructions. The draft rule set was validated and refined with 9 additional interviews with heart failure clinicians. Finally, the clinical champion of the project vetted the rule set. The concerns voiced by the clinicians during the interviews were noted, and methods to mitigate these concerns were employed. The rule set was then evaluated as part of a 6-month randomized controlled trial of a mobile phone-based heart failure Telemonitoring system ( n =50 for each of the Telemonitoring and control groups). Results The developed expert system generated alerts and instructions based on the patient's weight, blood pressure, heart rate, and symptoms. During the trial, 1620 alerts were generated, which led to various clinical actions including 105 medication changes/instructions. The findings from the trial indicated the rule set was associated with improved quality of life and self-care. Conclusions A rule set was developed with extensive input by heart failure clinicians. The results from the trial indicated the rule set was associated with significantly increased self-care and improved the clinical management of heart failure. The developed rule set can be used as a basis for other heart failure Telemonitoring systems, but should be validated and modified as necessary. In addition, the process used to develop the rule set can be generalized and applied to create robust and complete rule sets for other healthcare expert systems.
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mobile phone based Telemonitoring for heart failure management a randomized controlled trial
Journal of Medical Internet Research, 2012Co-Authors: Emily Seto, Kevin J Leonard, Joseph A Cafazzo, Jan Barnsley, Caterina Masino, Heather J RossAbstract:Background: Previous trials of Telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based Telemonitoring system have not been determined. Objective: The objective of this trial was to investigate the effects of a mobile phone-based Telemonitoring system on heart failure management and outcomes. Methods: One hundred patients were recruited from a heart function clinic and randomized into Telemonitoring and control groups. The Telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients’ mobile phones and alerts to a cardiologist’s mobile phone as required. Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of Telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the Telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the Telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the Telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the Telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics. Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based Telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones. Trial Registration: ClinicalTrials.gov NCT00778986 [J Med Internet Res 2012;14(1):e31]
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perceptions and experiences of heart failure patients and clinicians on the use of mobile phone based Telemonitoring
Journal of Medical Internet Research, 2012Co-Authors: Emily Seto, Kevin J Leonard, Joseph A Cafazzo, Jan Barnsley, Caterina Masino, Heather J RossAbstract:Background: Previous trials of heart failure Telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of Telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure Telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based Telemonitoring system for 6 months. The Telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The Telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the Telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from Telemonitoring. Some clinical concerns included ongoing costs of the Telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a Telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing Telemonitoring solutions. Key Words: The success of a Telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing Telemonitoring solutions. [J Med Internet Res 2012;14(1):e25]
Heather J Ross - One of the best experts on this subject based on the ideXlab platform.
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self management and clinical decision support for patients with complex chronic conditions through the use of smartphone based Telemonitoring randomized controlled trial protocol
JMIR Research Protocols, 2017Co-Authors: Emily Seto, Joseph A Cafazzo, Patrick Ware, Alexander G Logan, Kenneth R Chapman, Phillip Segal, Heather J RossAbstract:Background: The rising prevalence of chronic illnesses hinders the sustainability of the health care system because of the high cost of frequent hospitalizations of patients with complex chronic conditions. Clinical trials have demonstrated that Telemonitoring can improve health outcomes, but they have generally been limited to single conditions such as diabetes, hypertension, or heart failure. Few studies have examined the impact of Telemonitoring on complex patients with multiple chronic conditions, although these patients may benefit the most from this technology. Objective: The aim of this study is to investigate the impact of a smartphone-based Telemonitoring system on the clinical care and health outcomes of complex patients across several chronic conditions. Methods: A mixed-methods, 6-month randomized controlled trial (RCT) of a smartphone-based Telemonitoring system is being conducted in specialty clinics. The study will include patients who have been diagnosed with one or more of any of the following conditions: heart failure, chronic obstructive pulmonary disease, chronic kidney disease, uncontrolled hypertension, or insulin-requiring diabetes. The primary outcome will be the health status of patients as measured with SF-36. Patients will be randomly assigned to either the control group receiving usual care (n=73) or the group using the smartphone-based Telemonitoring system in addition to usual care (n=73). Results: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by the fall of 2018. Conclusions: This RCT will be among the first trials to provide evidence of the impact of Telemonitoring on costs and health outcomes of complex patients who may have multiple chronic conditions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 41238563; http://www.isrctn.com/ISRCTN41238563 (Archived by WebCite at http://www.webcitation.org/6ug2Sk0af) and Clinicaltrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 (Archived by WebCite at http://www.webcitation.org/6uvjNosBC) [JMIR Res Protoc 2017;6(11):e229]
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developing healthcare rule based expert systems case study of a heart failure Telemonitoring system
International Journal of Medical Informatics, 2012Co-Authors: Emily Seto, Kevin J Leonard, Joseph A Cafazzo, Jan Barnsley, Caterina Masino, Heather J RossAbstract:Abstract Background The use of expert systems to generate automated alerts and patient instructions based on Telemonitoring data could enable increased self-care and improve clinical management. However, of great importance is the development of the rule set to ensure safe and clinically relevant alerts and instructions are sent. The purpose of this work was to develop a rule-based expert system for a heart failure mobile phone-based Telemonitoring system, to evaluate the expert system, and to generalize the lessons learned from the development process for use in other healthcare applications. Methods Semi-structured interviews were conducted with 10 heart failure clinicians to inform the development of a draft heart failure rule set for alerts and patient instructions. The draft rule set was validated and refined with 9 additional interviews with heart failure clinicians. Finally, the clinical champion of the project vetted the rule set. The concerns voiced by the clinicians during the interviews were noted, and methods to mitigate these concerns were employed. The rule set was then evaluated as part of a 6-month randomized controlled trial of a mobile phone-based heart failure Telemonitoring system ( n =50 for each of the Telemonitoring and control groups). Results The developed expert system generated alerts and instructions based on the patient's weight, blood pressure, heart rate, and symptoms. During the trial, 1620 alerts were generated, which led to various clinical actions including 105 medication changes/instructions. The findings from the trial indicated the rule set was associated with improved quality of life and self-care. Conclusions A rule set was developed with extensive input by heart failure clinicians. The results from the trial indicated the rule set was associated with significantly increased self-care and improved the clinical management of heart failure. The developed rule set can be used as a basis for other heart failure Telemonitoring systems, but should be validated and modified as necessary. In addition, the process used to develop the rule set can be generalized and applied to create robust and complete rule sets for other healthcare expert systems.
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mobile phone based Telemonitoring for heart failure management a randomized controlled trial
Journal of Medical Internet Research, 2012Co-Authors: Emily Seto, Kevin J Leonard, Joseph A Cafazzo, Jan Barnsley, Caterina Masino, Heather J RossAbstract:Background: Previous trials of Telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based Telemonitoring system have not been determined. Objective: The objective of this trial was to investigate the effects of a mobile phone-based Telemonitoring system on heart failure management and outcomes. Methods: One hundred patients were recruited from a heart function clinic and randomized into Telemonitoring and control groups. The Telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients’ mobile phones and alerts to a cardiologist’s mobile phone as required. Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of Telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the Telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the Telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the Telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the Telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics. Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based Telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones. Trial Registration: ClinicalTrials.gov NCT00778986 [J Med Internet Res 2012;14(1):e31]
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perceptions and experiences of heart failure patients and clinicians on the use of mobile phone based Telemonitoring
Journal of Medical Internet Research, 2012Co-Authors: Emily Seto, Kevin J Leonard, Joseph A Cafazzo, Jan Barnsley, Caterina Masino, Heather J RossAbstract:Background: Previous trials of heart failure Telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs. Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of Telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure Telemonitoring. Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based Telemonitoring system for 6 months. The Telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach. Results: The Telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the Telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from Telemonitoring. Some clinical concerns included ongoing costs of the Telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system. Conclusions: The success of a Telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing Telemonitoring solutions. Key Words: The success of a Telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing Telemonitoring solutions. [J Med Internet Res 2012;14(1):e25]
John G F Cleland - One of the best experts on this subject based on the ideXlab platform.
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structured telephone support or non invasive Telemonitoring for patients with heart failure
Heart, 2017Co-Authors: Sally C Inglis, Robyn Clark, Riet Dierckx, David Prietomerino, John G F ClelandAbstract:Heart failure is a common and growing problem, worldwide, often leading to repeated hospitalisations, reduced quality of life, disability, loss of independence and shortened life expectancy. Managing heart failure is costly and complex for individual patients, their families and healthcare systems. A range of pharmacological agents, devices and disease management programmes have proven to be effective but are not available to all patients. Non-invasive Telemonitoring and structured telephone support for patients with heart failure have been researched for almost two decades; however the jury still appears to be out for the use of this intervention in clinical practice.1 The effectiveness of structured telephone support and non-invasive Telemonitoring to reduce hospitalisations and mortality in patients with heart failure was assessed by a recent Cochrane review.2 This review was undertaken as an update to a previously published version. Randomised controlled trials (RCTs) that compared structured telephone support or non-invasive Telemonitoring to standard practice were included. Studies were excluded if the Telemonitoring intervention included other interventions such as home visits or frequent clinic visits or implanted monitoring devices. Compared with the previously published Cochrane review, 17 new studies were identified and 24 had been included in the previous review (total of 41 studies). Two studies were multiarm and included both structured telephone support and Telemonitoring; hence there were 43 comparisons in the review. The primary outcomes included all-cause mortality and all-cause and heart failure related hospitalisations which were analysed using fixed-effects models. The review demonstrated that both non-invasive Telemonitoring and structured telephone support offer statistically and clinically meaningful benefits to people with heart failure.2 For non-invasive Telemonitoring, a 20% reduction in the risk of all-cause mortality was observed (Relative Risk (RR) 0.80, 95% Confidence Interval (CI) 0.68 to 0.94; participants=3740; studies=17; I2=24%; Grading of Recommendations Assessment, Development and …
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structured telephone support or non invasive Telemonitoring for patients with heart failure
Cochrane Database of Systematic Reviews, 2015Co-Authors: Sally C Inglis, Robyn Clark, Riet Dierckx, David Prietomerino, John G F ClelandAbstract:BackgroundSpecialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home Telemonitoring have been published which have raised questions about their effectiveness.ObjectivesTo review randomised controlled trials (RCTs) of structured telephone support or non-invasive home Telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care.Search methodsWe updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index-Science (CPCIS) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits.Selection criteriaWe included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home Telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up.Data collection and analysisWe present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age).Main resultsWe include 41 studies of either structured telephone support or non-invasive home Telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as Telemonitoring; total of 9332 participants), 18 evaluated Telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and Telemonitoring compared to usual care, therefore 43 comparisons are evident.Non-invasive Telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I-2 = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I-2 = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I-2 = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I-2 = 27%, GRADE: moderate-quality evidence).Neither structured telephone support nor Telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I-2 = 47%, GRADE: very low-quality evidence; non-invasive Telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I-2 = 71%, GRADE: very low-quality evidence).Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine Telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One Telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 Telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six Telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one Telemonitoring study reported a decrease in costs and two Telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medicalmanagement. Adherence was rated between 55.1% and 98.5% for those structured telephone support and Telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours.Authors' conclusionsFor people with heart failure, structured telephone support and non-invasive home Telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.
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is age a factor in the success or failure of remote monitoring in heart failure Telemonitoring and structured telephone support in elderly heart failure patients
Faculty of Health; Institute of Health and Biomedical Innovation, 2015Co-Authors: Sally C Inglis, John G F Cleland, Aaron Conway, Robyn ClarkAbstract:Background There are few data regarding the effectiveness of remote monitoring for older people with heart failure. We conducted a post-hoc sub-analysis of a previously published large Cochrane systematic review and meta-analysis of relevant randomized controlled trials to determine whether structured telephone support and Telemonitoring were effective in this population. Methods A post hoc sub-analysis of a systematic review and meta-analysis that applied the Cochrane methodology was conducted. Meta-analyses of all-cause mortality, all-cause hospitalizations and heart failure-related hospitalizations were performed for studies where the mean or median age of participants was 70 or more years. Results The mean or median age of participants was 70 or more years in eight of the 16 (n=2,659/5,613; 47%) structured telephone support studies and four of the 11 (n=894/2,710; 33%) Telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-1.00) and Telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99). Conclusion Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the randomized controlled trials, older people with heart failure did benefit from structured telephone support and Telemonitoring. These post-hoc sub-analysis results were similar to overall effects observed in the main meta-analysis. While further research is required to confirm these observational findings, the evidence at hand indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure.
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structured telephone support or Telemonitoring programs for patients with chronic heart failure
Cochrane Database of Systematic Reviews, 2010Co-Authors: Sally C Inglis, Robyn Clark, Finlay A Mcalister, Jocasta Ball, Christian Lewinter, Damien Cullington, Simon Stewart, John G F ClelandAbstract:Background Specialised disease management programmes for chronic heart failure (CHF) improve survival, quality of life and reduce healthcare utilisation. The overall efficacy of structured telephone support or Telemonitoring as an individual component of a CHF disease management strategy remains inconclusive. Objectives To review randomised controlled trials (RCTs) of structured telephone support or Telemonitoring compared to standard practice for patients with CHF in order to quantify the effects of these interventions over and above usual care for these patients. Search methods Databases (the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and Science Citation Index Expanded and Conference Citation Index on ISI Web of Knowledge) and various search engines were searched from 2006 to November 2008 to update a previously published non-Cochrane review. Bibliographies of relevant studies and systematic reviews and abstract conference proceedings were handsearched. No language limits were applied. Selection criteria Only peer reviewed, published RCTs comparing structured telephone support or Telemonitoring to usual care of CHF patients were included. Unpublished abstract data was included in sensitivity analyses. The intervention or usual care could not include a home visit or more than the usual (four to six weeks) clinic follow-up. Data collection and analysis Data were presented as risk ratio (RR) with 95% confidence intervals (CI). Primary outcomes included all-cause mortality, all-cause and CHF-related hospitalisations which were meta-analysed using fixed effects models. Other outcomes included length of stay, quality of life, acceptability and cost and these were described and tabulated. Main results Twenty-five studies and five published abstracts were included. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (5613 participants), 11 evaluated Telemonitoring (2710 participants), and two tested both interventions (included in counts). Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81, P < 0.0001) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01, P = 0.08). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87, P < 0.0001) and Telemonitoring (RR 0.79, 95% CI 0.67 to 0.94, P = 0.008) reduced CHF-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed. Authors' conclusions Structured telephone support and Telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.
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a systematic review of Telemonitoring for the management of heart failure
European Journal of Heart Failure, 2003Co-Authors: Amala A Louis, Tracy Turner, Marcia Gretton, Angela Baksh, John G F ClelandAbstract:Background: Telemonitoring allows a clinician to monitor, on a daily basis, physiological variables measured by patients at home. This provides a means to keep patients with heart failure under close supervision, which could reduce the rate of admission to hospital and accelerate discharge. Objective: To review the literature on the application of telemedicine in the management of heart failure. Methods: A literature search was conducted on studies involving Telemonitoring and heart failure between 1966 and 2002 using Medline, Embase, Cochrane Library and Journal of Telemedicine and Telecare. Results: Eighteen observational studies and six randomised controlled trials involving Telemonitoring and heart failure were identified. Observational studies suggest that Telemonitoring; used either alone or as part of a multidisciplinary care program, reduce hospital bed-days occupancy. Patient acceptance of and compliance with Telemonitoring was high. Two randomised controlled trials suggest that Telemonitoring of vital signs and symptoms facilitate early detection of deterioration and reduce readmission rates and length of hospital stay in patients with heart failure. One study also showed a reduction in readmission charges. One substantial randomised controlled study showed a significant reduction in mortality at 6 months by monitoring weight and symptoms in patients with heart failure; however, no difference was observed in readmission rates. Another randomised study comparing video-consultation performed as part of a home health care programme for patients with a variety of diagnoses, suggested a reduction in the costs of hospital care, which offset the cost of video-consultation. Patients with heart failure were not reported separately. One randomised study showed no difference in outcomes between the Telemonitoring group and the standard care group. Conclusion: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention.
Harlan M Krumholz - One of the best experts on this subject based on the ideXlab platform.
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impact of Telemonitoring on health status
Circulation-cardiovascular Quality and Outcomes, 2017Co-Authors: Natalie Jayaram, Yevgeniy Khariton, Harlan M Krumholz, Sarwat I Chaudhry, Jennifer A Mattera, Fengming Tang, Jeph Herrin, Beth Hodshon, John A SpertusAbstract:Background— Although noninvasive Telemonitoring in patients with heart failure does not reduce mortality or hospitalizations, less is known about its effect on health status. This study reports the results of a randomized clinical trial of Telemonitoring on health status in patients with heart failure. Methods and Results— Among 1521 patients with recent heart failure hospitalization randomized in the Tele-HF trial (Telemonitoring to Improve Heart Failure Outcomes), 756 received telephonic monitoring and 765 usual care. Disease-specific health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) within 2 weeks of discharge and at 3 and 6 months. Repeated measures linear regression models were used to assess differences in KCCQ scores between patients assigned to Telemonitoring and usual care over 6 months. The baseline characteristics of the 2 treatment arms were similar (mean age, 61 years; 43% female and 39% black). Over the 6-month follow-up period, there was a statistically significant, but clinically small, difference between the 2 groups in their KCCQ overall summary and subscale scores. The average KCCQ overall summary score for those receiving Telemonitoring was 2.5 points (95% confidence interval, 0.38–4.67; P =0.02) higher than usual care, driven primarily by improvements in symptoms (3.5 points; 95% confidence interval, 1.18–5.82; P =0.003) and social function (3.1 points; 95% confidence interval, 0.30–6.00; P =0.03). Conclusions— Telemonitoring results in statistically significant, but clinically small, improvements in health status when compared with usual care. Given that the KCCQ was a secondary outcome, the benefits should be confirmed in future studies. Clinical Trial Registration— URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00303212.
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Telemonitoring in patients with heart failure
The New England Journal of Medicine, 2010Co-Authors: Sarwat I Chaudhry, Jennifer A Mattera, Jeph Herrin, Beth Hodshon, John A Spertus, Jeptha P Curtis, Zhenqiu Lin, Christopher O Phillips, Lawton S Cooper, Harlan M KrumholzAbstract:Methods We randomly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either Telemonitoring (826 patients) or usual care (827 patients). Telemonitoring was accomplished by means of a telephone-based interactive voiceresponse system that collected daily information about symptoms and weight that was reviewed by the patients’ clinicians. The primary end point was readmission for any reason or death from any cause within 180 days after enrollment. Secondary end points included hospitalization for heart failure, number of days in the hospital, and number of hospitalizations. Results The median age of the patients was 61 years; 42.0% were female, and 39.0% were black. The Telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point, which occurred in 52.3% and 51.5% of patients, respectively (difference, 0.8 percentage points; 95% confidence interval [CI], −4.0 to 5.6; P = 0.75 by the chi-square test). Readmission for any reason occurred in 49.3% of patients in the Telemonitoring group and 47.4% of patients in the usualcare group (difference, 1.9 percentage points; 95% CI, −3.0 to 6.7; P = 0.45 by the chi-square test). Death occurred in 11.1% of the Telemonitoring group and 11.4% of the usual care group (difference, −0.2 percentage points; 95% CI, −3.3 to 2.8; P = 0.88 by the chi-square test). There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components. No adverse events were reported. Conclusions Among patients recently hospitalized for heart failure, Telemonitoring did not improve outcomes. The results indicate the importance of a thorough, independent evaluation of disease-management strategies before their adoption. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT00303212.)
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randomized trial of Telemonitoring to improve heart failure outcomes tele hf study design
Journal of Cardiac Failure, 2007Co-Authors: Sarwat I Chaudhry, Jennifer A Mattera, John A Spertus, Barbara A Barton, Harlan M KrumholzAbstract:Abstract Background Telemonitoring, the use of communication technology to monitor clinical status, is gaining attention as a strategy to improve the care of patients with heart failure. A system of frequent monitoring could alert clinicians to early heart failure decompensation, providing the opportunity for intervention before patients become severely ill and require hospitalization. Moreover, patients' participation in a daily monitoring program could have a favorable effect on their health behaviors. The literature on Telemonitoring for heart failure, however, is quite limited. Methods and Materials Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) is a randomized, controlled, trial designed to compare an automated, daily symptom, and self-reported weight monitoring intervention with usual care in reducing (all-cause) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The intervention will be implemented and all outcomes will be assessed over a 6-month period. The purpose of the intervention is to collect information about symptoms, clinical status and weight and to engage participants in their own self-care. Participants are recruited from general cardiology, heart failure specialty, and primary care practices across the United States. Conclusions The results of this study may inform future policy decisions regarding implementation of Telemonitoring in treatment of heart failure.
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Telemonitoring for patients with chronic heart failure a systematic review
Journal of Cardiac Failure, 2007Co-Authors: Sarwat I Chaudhry, Jennifer A Mattera, Christopher O Phillips, Simon Stewart, Barbara Riegel, Anthony F Jerant, Harlan M KrumholzAbstract:Background Telemonitoring, the use of communication technology to remotely monitor health status, is an appealing strategy for improving disease management.
Sarwat I Chaudhry - One of the best experts on this subject based on the ideXlab platform.
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impact of Telemonitoring on health status
Circulation-cardiovascular Quality and Outcomes, 2017Co-Authors: Natalie Jayaram, Yevgeniy Khariton, Harlan M Krumholz, Sarwat I Chaudhry, Jennifer A Mattera, Fengming Tang, Jeph Herrin, Beth Hodshon, John A SpertusAbstract:Background— Although noninvasive Telemonitoring in patients with heart failure does not reduce mortality or hospitalizations, less is known about its effect on health status. This study reports the results of a randomized clinical trial of Telemonitoring on health status in patients with heart failure. Methods and Results— Among 1521 patients with recent heart failure hospitalization randomized in the Tele-HF trial (Telemonitoring to Improve Heart Failure Outcomes), 756 received telephonic monitoring and 765 usual care. Disease-specific health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) within 2 weeks of discharge and at 3 and 6 months. Repeated measures linear regression models were used to assess differences in KCCQ scores between patients assigned to Telemonitoring and usual care over 6 months. The baseline characteristics of the 2 treatment arms were similar (mean age, 61 years; 43% female and 39% black). Over the 6-month follow-up period, there was a statistically significant, but clinically small, difference between the 2 groups in their KCCQ overall summary and subscale scores. The average KCCQ overall summary score for those receiving Telemonitoring was 2.5 points (95% confidence interval, 0.38–4.67; P =0.02) higher than usual care, driven primarily by improvements in symptoms (3.5 points; 95% confidence interval, 1.18–5.82; P =0.003) and social function (3.1 points; 95% confidence interval, 0.30–6.00; P =0.03). Conclusions— Telemonitoring results in statistically significant, but clinically small, improvements in health status when compared with usual care. Given that the KCCQ was a secondary outcome, the benefits should be confirmed in future studies. Clinical Trial Registration— URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00303212.
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Telemonitoring in patients with heart failure
The New England Journal of Medicine, 2010Co-Authors: Sarwat I Chaudhry, Jennifer A Mattera, Jeph Herrin, Beth Hodshon, John A Spertus, Jeptha P Curtis, Zhenqiu Lin, Christopher O Phillips, Lawton S Cooper, Harlan M KrumholzAbstract:Methods We randomly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either Telemonitoring (826 patients) or usual care (827 patients). Telemonitoring was accomplished by means of a telephone-based interactive voiceresponse system that collected daily information about symptoms and weight that was reviewed by the patients’ clinicians. The primary end point was readmission for any reason or death from any cause within 180 days after enrollment. Secondary end points included hospitalization for heart failure, number of days in the hospital, and number of hospitalizations. Results The median age of the patients was 61 years; 42.0% were female, and 39.0% were black. The Telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point, which occurred in 52.3% and 51.5% of patients, respectively (difference, 0.8 percentage points; 95% confidence interval [CI], −4.0 to 5.6; P = 0.75 by the chi-square test). Readmission for any reason occurred in 49.3% of patients in the Telemonitoring group and 47.4% of patients in the usualcare group (difference, 1.9 percentage points; 95% CI, −3.0 to 6.7; P = 0.45 by the chi-square test). Death occurred in 11.1% of the Telemonitoring group and 11.4% of the usual care group (difference, −0.2 percentage points; 95% CI, −3.3 to 2.8; P = 0.88 by the chi-square test). There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components. No adverse events were reported. Conclusions Among patients recently hospitalized for heart failure, Telemonitoring did not improve outcomes. The results indicate the importance of a thorough, independent evaluation of disease-management strategies before their adoption. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT00303212.)
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randomized trial of Telemonitoring to improve heart failure outcomes tele hf study design
Journal of Cardiac Failure, 2007Co-Authors: Sarwat I Chaudhry, Jennifer A Mattera, John A Spertus, Barbara A Barton, Harlan M KrumholzAbstract:Abstract Background Telemonitoring, the use of communication technology to monitor clinical status, is gaining attention as a strategy to improve the care of patients with heart failure. A system of frequent monitoring could alert clinicians to early heart failure decompensation, providing the opportunity for intervention before patients become severely ill and require hospitalization. Moreover, patients' participation in a daily monitoring program could have a favorable effect on their health behaviors. The literature on Telemonitoring for heart failure, however, is quite limited. Methods and Materials Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) is a randomized, controlled, trial designed to compare an automated, daily symptom, and self-reported weight monitoring intervention with usual care in reducing (all-cause) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The intervention will be implemented and all outcomes will be assessed over a 6-month period. The purpose of the intervention is to collect information about symptoms, clinical status and weight and to engage participants in their own self-care. Participants are recruited from general cardiology, heart failure specialty, and primary care practices across the United States. Conclusions The results of this study may inform future policy decisions regarding implementation of Telemonitoring in treatment of heart failure.
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Telemonitoring for patients with chronic heart failure a systematic review
Journal of Cardiac Failure, 2007Co-Authors: Sarwat I Chaudhry, Jennifer A Mattera, Christopher O Phillips, Simon Stewart, Barbara Riegel, Anthony F Jerant, Harlan M KrumholzAbstract:Background Telemonitoring, the use of communication technology to remotely monitor health status, is an appealing strategy for improving disease management.
