Division of Cardiovascular Medicine, Heart Failure Devices Clinic, Ohio State University Medical Center, Columbus, OH 43210, USA.
Eur Heart J. 2011 Jun;32(12):1457-64. doi: 10.1093/eurheartj/ehr005. Epub 2011 Feb 2.
Clinical management of refractory heart failure remains challenging, with a high rate of rehospitalizations despite advances in medical and device therapy. Care can be provided in person, via telehomecare (by telephone), or telemonitoring, which involves wireless technology for remote follow-up. Telemonitoring wirelessly transmits parameters such as weight, heart rate, or blood pressure for review by health-care professionals. Cardiac implantable devices (defibrillators and cardiac resynchronization therapy) also transmit continually interrogated physiological data, such as heart rate variability or intrathoracic impedance, which may be of value to predict patients at greater risk of hospitalization for heart failure. The use of remote monitoring techniques facilitates a rapid and regular review of such data by health-care workers as part of a heart failure management programme. Current evidence supports the feasibility of such an approach but routinely assessed parameters have been shown not to impact patient outcomes. Devices that directly assess cardiac haemodynamic status through invasive measurement of pressures are currently under investigation and could potentially increase the sensitivity and specificity of predicting heart failure events. The current evidence for telemonitoring and remote monitoring, including implantable haemodynamic devices, will be reviewed.
尽管在医学和器械治疗方面取得了进展，但难治性心力衰竭的临床管理仍然具有挑战性，再入院率仍然很高。可以通过面对面、远程家庭护理（通过电话）或远程监测来提供护理，远程监测涉及用于远程随访的无线技术。远程监测通过无线传输体重、心率或血压等参数，供医疗保健专业人员审查。心脏植入式设备（除颤器和心脏再同步治疗）还连续传输可询问的生理数据，例如心率变异性或胸腔内阻抗，这些数据可能有助于预测心力衰竭住院风险更高的患者。远程监测技术的使用便于医疗保健工作者快速和定期审查此类数据，作为心力衰竭管理计划的一部分。现有证据支持这种方法的可行性，但常规评估的参数并未显示对患者结局有影响。目前正在研究通过直接测量压力来评估心脏血液动力学状态的设备，这可能会提高预测心力衰竭事件的敏感性和特异性。将回顾远程监测和远程监测的现有证据，包括植入式血液动力学设备。
