It was a good, commonsense idea that simply didn’t work out.
Researchers thought that having heart failure patients who were freshly released from the hospital call their doctors’ offices daily to report their weight and symptoms might catch relapses earlier, allowing physicians to intervene quickly and save lives.
Unfortunately, that’s not what happened. Patients who called in regularly were just as likely to be readmitted to the hospital or to suffer a heart attack or die as were those who received normal care, according to a six-month clinical trial of 1,653 patients by Yale University.
“We had a lot of faith and hope that providing increased information could improve outcomes,” said Dr. Sarwat I. Chaudhry of Yale, who led the study reported at a Chicago meeting of the American Heart Assn. and online in the New England Journal of Medicine. “Obviously that wasn’t enough.”
Dr. Alfred Bove of Temple University, a past president of the American College of Cardiology, said he was disappointed in the findings. He said that they were at odds with a similar telemonitoring study of 50 patients by his group that found a significant reduction in hospital admissions, as have several other small studies. A key difference: Most of those studies employed a patient coordinator who talked directly to the patients, whereas the Yale study used an automated system.
One problem in the latest study was that 14% of the patients never made the phone calls they were supposed to. And by week 26, only 55% were making at least three calls per week. Those numbers are similar to the proportion of patients that have been shown in other studies to actually take their medications, Chaudhry said.
Still, the telemonitoring scheme might work well for certain patients, said Dr. Stefan Anker of the Charite University Medical School in Berlin. His telemonitoring study of 710 heart failure patients for 26 months found that results were very poor for certain patients, such as those who suffered from depression, who had not been hospitalized and whose hearts pumped the lowest fraction of blood on each beat.
But the program was successful in reducing deaths and hospitalizations for the rest of the patients, he noted. “Telemedicine is not for everyone. It should be for a select group of patients,” he said.