Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital, Saarland University, Germany.
Department of Internal Medicine II, Cardiology, Angiology and Pneumology, Klinikum Coburg GmbH, Germany.
J Telemed Telecare. 2024 Jan;30(1):173-179. doi: 10.1177/1357633X211039398. Epub 2021 Sep 15.
In the OptiLink heart failure study, timely and appropriate reactions to telemedicine alerts improved clinical outcomes in heart failure patients. This analysis investigates the relation between the weekday of alert transmission and the subsequent patient contact.
In patients enrolled in the intervention arm of the OptiLink heart failure study ( = 505, age 66.1 ± 10.1, 77.2% male, left-ventricular ejection fraction 26.7% ± 6.1%), fluid index threshold crossing alerts were analysed according to the weekday of the transmission. Transmissions on Mondays-Thursdays were categorized as TD1, Fridays-Sundays as well as public holidays as TD2.
Of 1365 transmitted alerts, 867 (63.5%) were categorized as TD1 and 498 (36.5%) as TD2. Same day telephone contacts were more frequent in TD1 (46.2%) than in TD2 (18.3%; < 0.001). Accordingly, the median time to contact was significantly longer in TD2 compared with TD1 (2(1-3) vs 0(0-1) days; < 0.001). Rates of no telephone contact were no different between the groups (12.1% vs 12.4%; = 0.866). Although signs of worsening heart failure were prevalent in 32.4% in TD1 versus 32.1% in TD2 ( = 0.996), initiation of a pharmacological intervention occurred more likely in TD1 compared with TD2 (27.9% vs 22.9%; = 0.041). No differences existed concerning hospitalization for heart failure within 30 days after alert transmission (3.9% vs 3.4%; = 0.636).
Alert transmissions during weekends and public holidays were less likely associated with timely patient contacts and initiation of pharmacological interventions than during the week. Telemedical centres providing 24/7 remote monitoring service and specific education programmes for physicians might help to optimize patient care.
在 OptiLink 心力衰竭研究中，对远程医疗警报的及时和适当反应改善了心力衰竭患者的临床结局。本分析研究了警报传输的星期与随后的患者联系之间的关系。
在 OptiLink 心力衰竭研究的干预组中纳入的患者（ = 505 例，年龄 66.1 ± 10.1 岁，77.2%为男性，左心室射血分数 26.7% ± 6.1%）中，根据警报传输的星期分析了液体指数阈值越界警报。周一至周四传输的警报归类为 TD1，周五至周日以及公共假日传输的警报归类为 TD2。
在 1365 次传输的警报中，867 次（63.5%）归类为 TD1，498 次（36.5%）归类为 TD2。TD1 的当天电话联系更为频繁（46.2%），而 TD2 的电话联系较少（18.3%； < 0.001）。因此，TD2 与 TD1 相比，联系的中位时间明显更长（2(1-3) 天 vs 0(0-1) 天； < 0.001）。两组之间无电话联系的发生率无差异（12.1% vs 12.4%； = 0.866）。尽管 TD1 组中有 32.4%的患者心力衰竭恶化迹象明显，而 TD2 组中则有 32.1%（ = 0.996），但与 TD2 相比，TD1 更有可能开始进行药物干预（27.9% vs 22.9%； = 0.041）。在警报传输后 30 天内，因心力衰竭住院的情况在两组之间无差异（3.9% vs 3.4%； = 0.636）。
与一周内相比，周末和公共假日的警报传输与及时的患者联系和药物干预的启动不太相关。提供 24/7 远程监测服务和针对医生的特定教育计划的远程医疗中心可能有助于优化患者护理。
