Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.
Department of Medicine, Viborg Regional Hospital, Viborg, Denmark.
J Telemed Telecare. 2024 Oct;30(9):1417-1424. doi: 10.1177/1357633X221150279. Epub 2023 Jan 23.
Acute exacerbations of chronic obstructive pulmonary disease are associated with high morbidity and mortality. Telemonitoring may reduce the frequency of hospitalization. The aim of this study was to investigate the effect of telemonitoring on hospitalization rates for acute exacerbations of chronic obstructive pulmonary disease.
Patients were recruited during hospitalization and equally randomized to telemonitoring or usual care. Telemonitoring participants recorded symptoms and monitored oxygen saturation, heart rate, peak expiratory flow, and body weight. Alerts were generated if readings breached thresholds. Acute exacerbations of chronic obstructive pulmonary disease hospitalizations during the 6 months intervention were compared using logistic regression, and time to first hospitalization was assessed using Cox proportional hazard modeling. The incidence rates for acute exacerbations of chronic obstructive pulmonary disease hospitalization were compared using a negative binomial regression model with between-group comparisons expressed as incidence rate ratios. The telemonitoring group was used as reference.
A total of 222 patients were randomized. 37/112 (33%) in the control group and 31/110 (28%) in the telemonitoring group experienced acute exacerbations of chronic obstructive pulmonary disease hospitalization during the intervention period, odds ratio of 1.26, confidence interval 0.71-2.23, = 0.4. No difference was seen in time to first hospitalization, hazard ratio 1.23, CI 0.77-1.99, = 0.4. The number of hospitalizations in the intervention period was 66 in the control group and 42 in the telemonitoring group, with incidence rate ratio 1.42, confidence interval 1.04-1.95, = 0.03. Adjustment for dyspnea score, smoking, and cohabitation status did not change the results, incidence rate ratio 1.44, confidence interval 1.05-1.99, = 0.02.
Patients who received telemonitoring experienced significantly fewer acute exacerbations of chronic obstructive pulmonary disease hospitalizations, although the overall risk of having at least one hospitalization and the time to first hospitalization was similar between the two groups.
慢性阻塞性肺疾病（COPD）的急性加重与高发病率和死亡率相关。远程监测可能会降低住院频率。本研究旨在探讨远程监测对 COPD 急性加重住院率的影响。
患者在住院期间被招募，并被平均随机分配至远程监测组或常规护理组。远程监测组参与者记录症状并监测血氧饱和度、心率、呼气峰流速和体重。如果读数超过阈值，则会生成警报。使用逻辑回归比较 6 个月干预期间 COPD 急性加重的住院情况，使用 Cox 比例风险模型评估首次住院时间。使用负二项回归模型比较 COPD 急性加重的住院发生率，并用组间比较表示为发病率比。以远程监测组为参考。
共随机分配了 222 名患者。对照组中有 37/112（33%）患者和远程监测组中有 31/110（28%）患者在干预期间经历了 COPD 急性加重住院，比值比为 1.26，置信区间为 0.71-2.23， = 0.4。首次住院时间无差异，风险比为 1.23，CI 为 0.77-1.99， = 0.4。对照组干预期间的住院次数为 66 次，远程监测组为 42 次，发病率比为 1.42，置信区间为 1.04-1.95， = 0.03。调整呼吸困难评分、吸烟和同居状况并未改变结果，发病率比为 1.44，置信区间为 1.05-1.99， = 0.02。
接受远程监测的患者经历的 COPD 急性加重住院次数明显减少，尽管两组之间至少有一次住院的总体风险和首次住院时间相似。
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