Cardiology Department, Hôpital Lapeyronie, PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, INI-CRT, Montpellier, France.
Economic Evaluation Unit (URME), University Hospital of Montpellier, Montpellier, France.
Eur J Heart Fail. 2024 May;26(5):1201-1214. doi: 10.1002/ejhf.3191. Epub 2024 Mar 7.
AIMS: Evaluating the benefit of telemonitoring in heart failure (HF) management in real-world settings is crucial for optimizing the healthcare pathway. The aim of this study was to assess the association between a 6-month application of the telemonitoring solution Chronic Care Connect™ (CCC) and mortality, HF hospitalizations, and associated costs compared with standard of care (SOC) in patients with a diagnosis of HF. METHODS AND RESULTS: From February 2018 to March 2020, a retrospective cohort study was conducted using the largest healthcare insurance system claims database in France (Système National des Données de Santé) linked to the CCC telemonitoring database of adult patients with an ICD-10-coded diagnosis of HF. Patients from the telemonitoring group were matched with up to two patients from the SOC group based on their high-dimensional propensity score, without replacement, using the nearest-neighbour method. A total of 1358 telemonitored patients were matched to 2456 SOC patients. The cohorts consisted of high-risk patients with median times from last HF hospitalization to index date of 17.0 (interquartile range: 7.0-66.0) days for the telemonitoring group and 27.0 (15.0-70.0) days for the SOC group. After 6 months, telemonitoring was associated with mortality risk reduction (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.56-0.89), a higher risk of first HF hospitalization (HR 1.81, 95% CI 1.55-2.13), and higher HF healthcare costs (relative cost 1.38, 95% CI 1.26-1.51). Compared with the SOC group, the telemonitoring group experienced a shorter average length of overnight HF hospitalization and fewer emergency visits preceding HF hospitalizations. CONCLUSION: The results of this nationwide cohort study highlight a valuable role for telemonitoring solutions such as CCC in the management of high-risk HF patients. However, for telemonitoring solutions based on weight and symptoms, consideration should be given to implement additional methods of assessment to recognize imminent worsening of HF, such as impedance changes, as a way to reduce mortality risk and the need for HF hospitalizations. Further studies are warranted to refine selection of patients who could benefit from a telemonitoring system and to confirm long-term benefits in high-risk and stable HF patients.
目的：在真实环境中评估远程监护在心力衰竭（HF）管理中的益处对于优化医疗保健途径至关重要。本研究的目的是评估与标准护理（SOC）相比，使用远程监护解决方案 Chronic Care Connect™（CCC）治疗 6 个月与 HF 死亡率、HF 住院率和相关成本之间的关联，该方案适用于 HF 诊断患者。
方法和结果：2018 年 2 月至 2020 年 3 月，使用法国最大的医疗保健保险系统索赔数据库（Système National des Données de Santé）进行了一项回顾性队列研究，该数据库与 CCC 远程监护数据库相关联，数据库中包含 ICD-10 编码 HF 诊断的成年患者。根据高维倾向评分，使用最近邻方法对远程监护组的患者进行了无替换的最多与 SOC 组的两名患者进行配对。共有 1358 名接受远程监护的患者与 2456 名 SOC 患者配对。队列由高危患者组成，从上次 HF 住院到指数日期的中位时间分别为远程监护组的 17.0（四分位距 [IQR]：7.0-66.0）天和 SOC 组的 27.0（15.0-70.0）天。6 个月后，远程监护与死亡率降低相关（风险比 [HR] 0.71，95%置信区间 [CI] 0.56-0.89）、首次 HF 住院风险增加（HR 1.81，95% CI 1.55-2.13）和更高的 HF 医疗保健成本（相对成本 1.38，95% CI 1.26-1.51）。与 SOC 组相比，远程监护组经历了较短的平均夜间 HF 住院时间和 HF 住院前急诊就诊次数减少。
结论：这项全国性队列研究的结果强调了像 CCC 这样的远程监护解决方案在管理高危 HF 患者方面的重要作用。然而，对于基于体重和症状的远程监护解决方案，应考虑实施其他评估方法，以识别 HF 恶化的迹象，例如阻抗变化，从而降低死亡率和 HF 住院的风险。需要进一步研究来完善选择可能受益于远程监护系统的患者，并确认高危和稳定 HF 患者的长期获益。
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