Dar Owais, Riley Jillian, Chapman Callum, Dubrey Simon W, Morris Stephen, Rosen Stuart D, Roughton Michael, Cowie Martin R
National Heart & Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK.
Eur J Heart Fail. 2009 Mar;11(3):319-25. doi: 10.1093/eurjhf/hfn050. Epub 2009 Jan 27.
Heart failure chiefly affects the elderly, with frequent emergency admissions. Telemonitoring can identify worsening heart failure but previous randomized trials have enrolled selected patient populations. The Home-HF study examined the impact of home telemonitoring on typical heart failure patients discharged from three acute hospitals in North West London, UK.
Patients hospitalized with heart failure were randomized to telemonitoring or usual specialist care. Primary outcome measures were days alive and out of hospital. Secondary outcome measures were number and duration of heart failure hospitalizations, clinic visits, and quality of life. We recruited 182 patients. There was no difference in the primary outcome measure in the two groups, but there were significantly fewer unplanned hospitalizations for heart failure decompensation, and a reduction in clinic and emergency room visits in the telemonitoring group. There was no statistically significant difference in the mean direct health service costs.
Home telemonitoring in a typical elderly population of heart failure patients produces a similar outcome to 'usual' specialist care, but reduces clinic and emergency room visits and unplanned heart failure rehospitalizations at little additional cost. This method of disease monitoring may allow specialist services to increase the number of patients under their care.
心力衰竭主要影响老年人,且常需紧急入院治疗。远程监测可识别心力衰竭病情恶化情况,但既往随机试验纳入的是特定患者群体。“家庭心力衰竭(Home-HF)”研究考察了家庭远程监测对英国伦敦西北部三家急症医院出院的典型心力衰竭患者的影响。
因心力衰竭住院的患者被随机分为接受远程监测组或常规专科护理组。主要结局指标为存活且未住院的天数。次要结局指标为心力衰竭住院次数、住院时长、门诊就诊次数及生活质量。我们招募了182名患者。两组的主要结局指标无差异,但远程监测组因心力衰竭失代偿导致的非计划住院显著减少,门诊和急诊就诊次数也有所减少。平均直接医疗服务成本无统计学显著差异。
对典型的老年心力衰竭患者进行家庭远程监测,其结果与“常规”专科护理相似,但能减少门诊和急诊就诊次数以及非计划的心力衰竭再住院次数,且几乎不增加额外成本。这种疾病监测方法可能使专科服务机构能够增加其护理的患者数量。