Home Monitoring of Chronic Heart Failure

Company: Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Email: To access the email, please, log in or sign up.

Article type: Review article

Keywords: heart failure, heart failure monitoring system, telemonitoring

Abstract

Original Text © Bockeria OL, Ispiryan AYu, published in Annaly aritmologii 2012; 9(2): 14-22.

Being a common syndrome chronic heart failure (CHF) results in high mortality among cardiosurgical patients and requires very high expenditures for the treatment. All over the world the number of patients with CHF syndrome is about 22 millions. Heart failure is difficult to treat because of high level of hospitalization due to decompensation. Care aimed at constant home observation of patients could have been more efficient and not only symptomatic and as a response to complications induced. There are methods controlling CHF patients at home. These methods vary from increase of se^care and telephone support to telemonitoring and remote monitoring of implantable devices. Selfscare includes such components as maintenance of drug intake, keeping to a diet, physical exercises and active control over edemas. Telephone calls are also a source of monitoring and treatment of heart failure at home. MetaSanalysis of programs for structured phone support showed that telephone support could reduce the level of readmission of HF patients approximately by 25%. Telemonitoring implies transmission of such physiological data as blood pressure, body weight, electrocardiographic signals or oxygen saturation using phone lines, broadband and satellite or wireless networks. Having cardiac pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy devices that are placed in HF patients, it is possible to use their opportunities for the further evaluation of the patient. Some regularly controlled parameters can show the clinical state of the patient and predict the following heart failure. For example, atrial fibrillation, decrease of cardiac rhythm variability and decrease of the level of the patient's activity (according to integrated accelerometer) can predict clinical decompensation. Also, implantable hemodynamic monitors for immediate pressure measuring in the left atrium, sensor system of pressure measuring in the right atrium are developed. Added advantages of implanted devices have the possibility to control the variables in the course of time, medium values during the day and also to show the clinical state of the patient. Further studies to define which patients will get the greatest benefit from the outpatient therapy are required. Monitoring without appropriate followsup and the patient's feedback that prevent from readmission or decompensation in heart failure.

References

Ageev FT, Danielyan MO, Mareev VYu et al. Patients with chronic heart failure in the russian outpatient practice: contingent features, diagnosis and treatment. Heart failure 2004; 5(1): 4-7. [Article in Russian].
Jovicic A, Holroyd-Leduc JM, Straus SE. Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovasc Disord 2006; (6): 43. PMID:17081306, DOI:10.1186/1471-2261-6-43.
Krum H. Telemonitoring of fluid status in heart failure: CHAMPION. Lancet 2011; 377(9766): 616-8. PMID:21315440, D0I:10.1016/S0140-6736(11)60164-5.
Bui AL, Fonarow GC. Home monitoring for heart failure management. J Am Coll Cardiol 2012; 59(2): 97-104. PMID:22222071, D0I:10.1016/j.jacc.2011.09.044.
Riegel B, Moser DK, Anker SD et al. State of the science: promoting selfcare in persons with heart failure: a scientific statement from the American Heart Association. Circulation 2009; 120(12): 1141-63. PMID:19720935, D0I:10.1161/CIRCULATI0NAHA.109.192628.
Chaudhry SI, Wang Y, Concato J et al. Patterns of weight change preceding hospitalization for heart failure. Circulation 2007; 116(14): 154954. PMID:17846286, D0I:10.1161/CIRCULATI0NAHA.107.690768.
Moser DK, Doering LV, Chung ML. Vulnerabilities of patients recovering from an exacerbation of chronic heart failure. Am Heart J 2005; 150(5): 984. PMID:16290979, DOI:10.1016/j.ahj.2005.07.028.
Lewin J, Ledwidge M, O'Loughlin C et al. Clinical deterioration in established heart failure: what is the value of BNP and weight gain in aiding diagnosis? Eur J Heart Fail 2005; 7(6): 953-7. PMID:16227134, DOI:10.1016/j.ejheart.2005.06.003.
Lien CT, Gillespie ND, Struthers AD et al. Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 2002; 4(1): 91-8. PMID:11812669, DOI:10.1016/S1388-9842(01)00200-8.
Gazmararian JA, Baker DW, Williams MV et al. Health literacy among Medicare enrollees in a managed care organization. JAMA 1999; 281(6): 545-51. PMID:10022111, DOI:10.1001/jama.281.6.545.
Powell LH, Calvin JE Jr, Richardson D et al. Self-management counseling in patients with heart failure: the heart failure adherence and retention randomized behavioral trial. JAMA 2010; 304(12): 1331-8. PMID:20858878, DOI:10.1001/jama.2010.1362.
Dickstein K, Cohen-Solal A, Filippatos G et ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29(19): 2388-442. PMID:18799522, DOI:10.1093/eurheartj/ehn309.
Hunt SA, American College of Cardiology; American Heart Association Task Force on Practice Guidelines. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005; 46(6): e1-82. PMID:16168273, DOI:10.1016/j.jacc.2005.08.022.
Rich MW, Beckham V, Wittenberg C et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995; 333(18): 1190-5. PMID:7565975, D0I:10.1056/NEJM199511023331806.
Inglis SC, Clark RA, McAlister FA et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010; (8): CD007228. PMID:20687083, DOI:10.1002/14651858.CD007228.pub2.
Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. N Engl J Med 1996; 334(22): 1441-7. PMID:8618584, D0I:10.1056/ NEJM199605303342206.
Riegel B, Carlson B, Kopp Z et al. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med. 2002; 162(6): 705-12. PMID:11911726, DOI:10.1001/archinte.162.6.705.
Klersy C, De Silvestri A, Gabutti G et al. A meta-analysis of remote monitoring of heart failure patients. J Am Coll Cardiol. 2009; 54(18): 168394. PMID:19850208, DOI:10.1016/j.jacc.2009.08.017.
Chaudhry SI, Mattera JA, Curtis JP et al. Telemonitoring in patients with heart failure. N Engl J Med 2010; 363(24): 2301-9. PMID:21080835, D0I:10.1056/NEJMoa1010029.
Koehler F, Winkler S, Schieber M et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation 2011; 123(17): 1873-80. PMID:21444883, D0I:10.1161/CIRCULATI0NAHA.111.018473.
GESICA Investigators. Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ 2005; 331(7514): 425. PMID:16061499, DOI:10.1136/bmj.38516.398067.E0.
Desai AS, Stevenson LW. Connecting the circle from home to heart-failure disease management. N Engl J Med. 2010; 363(24): 2364-7. PMID:21080836, DOI:10.1056/NEJMe1011769.
Fonarow GC, Abraham WT, Albert NM et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008; 168(8): 847-54. PMID:18443260, D0I:10.1001/archinte.168.8.847.
Bockeria OL, Zavarina AYu. Outpatient ECG monitoring: Holter monitoring, events recorders, external and implantable cardiomonitors. Annaly aritmologii 2009; 6(4): 33-40. [Article in Russian]. eLIBRARY.RU:12989835.
Yu CM, Wang L, Chau E et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 2005; 112(6): 841-8. PMID:16061743, DOI:10.1161/CIRCULATIONAHA.104.492207.
Abraham WT, Compton S, Haas G et al. Intrathoracic impedance vs daily weight monitoring for predicting worsening heart failure events: results of the Fluid Accumulation Status Trial (FAST). Congest Heart Fail 2011; 17(2): 51-5. PMID:21449992, D0I:10.1111/j.1751-7133.2011.00220.x.
Whellan DJ, Ousdigian KT, Al-Khatib SM et al. Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study. J Am Coll Cardiol. 2010; 55(17): 1803-10. PMID:20413029, DOI:10.1016/j.jacc.2009.11.089.
Crossley GH, Chen J, Choucair W et al. Clinical benefits of remote versus transtelephonic monitoring of implanted pacemakers. J Am Coll Cardiol 2009; 54(22): 2012-9. PMID:19926006, DOI:10.1016/j.jacc.2009.10.001.
Varma N, Epstein AE, Irimpen A et al. Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) trial. Circulation. 2010; 122(4): 325-32. PMID:20625110, DOI:10.1161/ CIRCULATIONAHA.110.937409.
Whellan DJ, Hasselblad V, Peterson E, et al. Metaanalysis and review of heart failure disease management randomized controlled clinical trials. Am Heart J 2005; 149(4): 722-9. PMID:15990759, DOI:10.1016/j.ahj.2004. 09.023.
Zile MR, Bennett TD, St John Sutton M et al. Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 2008; 118(14): 1433-41. PMID:18794390, DOI:10.1161/ CIRCULATIONAHA.108.783910.
Adamson PB, Magalski A, Braunschweig F et al. Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system. J Am Coll Cardiol 2003; 41(4): 565-71. PMID:12598066, DOI:10.1016/S0735-1097(02)02896-6.
Magalski A, Adamson P, Gadler F et al. Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-month follow-up study of patients with chronic heart failure. J Card Fail 2002; 8(2): 63-70. PMID:12016628, DOI:10.1054/jcaf.2002.32373.
Ritzema J, Troughton R, Melton I et al. Physician-directed patient selfmanagement of left atrial pressure in advanced chronic heart failure. Circulation. 2010; 121(9): 1086-95. PMID:20176990, DOI:10.1161/ CIRCULATIONAHA.108.800490.
Bourge RC, Abraham WT, Adamson PB et al. Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study. J Am Coll Cardiol 2008; 51(11): 1073-9. PMID:18342224, DOI:10.1016/j.jacc.2007.10.061.
Stevenson LW, Zile M, Bennett TD, Kueffer FJ, et al. Chronic ambulatory intracardiac pressures and future heart failure events. Circ Heart Fail 2010; 3(5):580-7. PMID:20562255, DOI:10.1161/CIRCHEARTFAILURE.109.923300.
Verdejo HE, Castro PF, Concepcion R et al. Comparison of a radiofrequency-based wireless pressure sensor to swan-ganz catheter and echocardiography for ambulatory assessment of pulmonary artery pressure in heart failure. J Am Coll Cardiol 2007; 50(25): 2375-82. PMID:18154961, DOI:10.1016/j.jacc.2007.06.061.
Abraham WT, Adamson PB, Bourge RC et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377(9766): 658-66. PMID:21315441, DOI:10.1016/S0140-6736(11)60101-3.
Porapakkham P, Porapakkham P, Zimmet H et al. B-type natriuretic peptide-guided heart failure therapy: A meta-analysis. Arch Intern Med 2010; 170(6): 507-14. PMID:20308637, DOI:10.1001/archinternmed. 2010.35.
Scherr D, Kastner P, Kollmann A, et al. Effect of home-based telemonitoring using mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation: randomized controlled trial. J Med Internet Res 2009; 11(3): e34. PMID:19687005, DOI:10.2196/jmir.1252.
Evangelista LS, Dracup K, Doering LV. Treatment-seeking delays in heart failure patients. J Heart Lung Transplant 2000; 19(10): 932-8. PMID:11044686, DOI:10.1016/S1053-2498(00)00186-8.
Kiselev AR, Gridnev VI, Shvartz VA et al. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension. J Am Soc Hypertens 2012; 6(5): 346-55. PMID:22995803, DOI:10.1016/j.jash.2012.08.001.

About Authors

Bockeria Olga L. — MD, PhD, Dr. Med. Sci., Professor, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia;

Ispiryan Artak Yu. - MD, Bakoulev Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences, Moscow, Russia.