Prescher S, Deckwart O, Koehler K, Lücke S, Schieber M, Wellge B, Winkler S, Baumann G, Koehler F
Charité-Universitätsmedizin Berlin, Med. Klinik m.S. Kardiologie und Angiologie, Zentrum für kardiovaskuläre Telemedizin, Berlin.
Kardiologische Gemeinschaftspraxis Stuttgart-Feuerbach, Stuttgart.
Dtsch Med Wochenschr. 2014 Apr;139(16):829-34. doi: 10.1055/s-0034-1369849. Epub 2014 Apr 10.
Remote Patient Management for chronic heart failure (CHF) is gaining increasing importance in health care. Telemonitoring is defined as daily measuring of health parameters by the patient and their transmission to a telemedical centre. The adherence of this action by the patient can be considered as a measure for RPM adoption.
The randomized controlled clinical trial TIM-HF (NCT 00543881) was conducted between 2008 and 2010 with 710 CHF patients with the primary endpoint total mortality for a mean follow-up of 21.5 ± 7.2 months. The non-prespecified analysis of adherence to daily measuring of ECG, blood pressure, weight and self-assessment was focused on sociodemographic and disease-related factors of the 354 RPM patients.
The mean adherence to telemonitoring was more than 80% (absolute adherence: 81.8 ± 22.8%, relative adherence: 88.9 ± 21.5%). From the beginning of treatment 6.5% of the patients (23/354) have shown an adherence below average. The high adherence of the majority of the patients was stable for the entire study duration and irrespective of age, sex, severity of the disease and the presence of mild to moderate depression.
A high adherence can be achieved by individual training of the patient regarding the handling of his disease, the use of telemedical devices and an easy-to-use telemonitoring system. The majority of the informed self-determined CHF patients NYHA class II/III are adopting telemonitoring and are adherent in the long term.
慢性心力衰竭（CHF）的远程患者管理在医疗保健中的重要性日益增加。远程监测被定义为患者每天测量健康参数并将其传输到远程医疗中心。患者对这一行为的依从性可被视为采用远程患者管理的一项指标。
2008年至2010年期间进行了随机对照临床试验TIM-HF（NCT 00543881），纳入710例CHF患者，主要终点为全因死亡率，平均随访21.5±7.2个月。对354例接受远程患者管理患者的心电图、血压、体重每日测量及自我评估依从性的非预先设定分析，聚焦于社会人口统计学和疾病相关因素。
远程监测的平均依从性超过80%（绝对依从性：81.8±22.8%，相对依从性：88.9±21.5%）。从治疗开始，6.5%的患者（23/354）依从性低于平均水平。大多数患者的高依从性在整个研究期间保持稳定，且与年龄、性别、疾病严重程度以及轻度至中度抑郁的存在无关。
通过对患者进行关于疾病管理、远程医疗设备使用和易于使用的远程监测系统的个体培训，可以实现高依从性。大多数知情且自主的纽约心脏协会（NYHA）II/III级CHF患者正在采用远程监测并长期保持依从性。
