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Chronic heart failure (CHF) is a frequent syndrome with an increasing prevalence. It is a frequent cause of impeding symptoms, has a negative prognosis and absorbs about two percent of the budgets of health-care systems in the industrialized nations.
Optimal management of patients with chronic heart failure has to detect emerging symptoms of a beginning hemodynamic imbalance in time and to administer an appropriate therapy in order to avoid decompensation and hospital admission. Telemonitoring of physiological and clinical parameters supplies valuable information to improve health care of these patients.
The TeleMedical Centre of Brandenburg provides continuous telemonitoring of multiple disease-relevant parameters to 40 patients since more than 1 year. A user-friendly home based electronic device registers weight, blood pressure, heart rate and rhythm by means of ECG, ventilation frequency and oxygen saturation of the blood. In addition, the patient uses a schematic code to enter details on his subjective state of health, changes of medication and an optional contact request. Once per day the information is sent via e-mail to the Telemedical Centre where it is evaluated. If the critical limits of individually defined parameters are crossed the primary care provider is promptly notified by fax. So treatment can be adjusted before heartfailure deteriorates and hospital admissions becomes necessary.
Feasibility and effectiveness of the continuous telemonitoring of multiple disease-relevant parameters were evaluated. Patients with CHF (NYHA III-IV) with at least one hospital admission due to acute decompensation within in the preceding year were enrolled in our study. After receiving an in hospital optimum treatment telemonitoring was started immediately after discharge. Patients were supplied with a Telemonitoring System in order to record the above described multiple parameters daily. Data were monitored daily and assessed by specialized physicians whether defined thresholds values were exceeded. An information about imminent hemodynamic imbalance was immediately sent to the responsible general practitioner by fax-transmission.
Forty patients (32 men, 8 women) with a mean age was 65 plus or minus 10,5 years (men 64 plus or minus 10, women 67 plus or minus 10,5) participated. Etiology of CHF was coronary heart disease, cardiomyopathie, hypertension and others. Total number of data-transmissions was 9686. Practitioners were informed about imminent hemodynamic imbalance because of weight gain, sudden changes in heart rhythm (paroxysmal atrial fibrillation, bradycardia, non sustaining VT) or patients assessment of critical symptoms. A change of therapy and stabilization of hemodynamic imbalance without re-admission to hospital could be observed in the majority of cases. Patients reported about a gain in the feeling of security and possibility to manage their severe disease.
Telemonitoring of multiple vital parameters of patients with chronic heart disease is feasible. Even elder patients can handle a well designed modern technological device. Symptoms of hemodynamic imbalance can be registered in time and responsible practitioners respond to urgently transmitted information. Health care of patients with chronic heart failure can be improved and hospital re-admissions can be avoided. Further investigations are necessary to determine effects of continuous telemonitoring of multiple disease-relevant parameters on long time prognosis and mortality.