Result card

  • CUR12: What are the differences in the management for different stages of the disease or health condition?
English

What are the differences in the management for different stages of the disease or health condition?

Authors: Ingrid Wilbacher, Nadine Berndt, Francesca Gillespie

Internal reviewers: Alessandra Lo Scalzo, Christian Vladescu, Christina Mototolea, Kristina Lampe, Maria Camerlingo

Basis search was not sufficient and a search (mainly on Medline) of all available guidelines in English was done. No quality assessment of guidelines was done. Focus was made on telemonitoring indications within the reviewed guidelines. Three additional studies were included during the consultation phase.

There is interest in new approaches of telemonitoring {1}, but at the moment there is no guideline recommendation available (possible) {45,24,1,110,3,33,44} for telemonitoring in general but for multidisciplinary CHF management programmes {87}.

Following is a brief description of how telemonitoring is included in available guidelines:

The Global heart failure Awareness Programme (Heart failure: preventing disease and death worldwide.  http://www.escardio.org/communities/HFA/Documents/WHFA-whitepaper-15-May-14.pdf?hot=highlighton) {45} includes telemonitoring devices among the new approaches to long-term management outside hospital and encourage more research on these approaches before recommending for they are promising but yet failing to provide clear improval of survival.

The ESC guideline {77} states that for telemonitoring with implantable devices, a guideline recommendation is not yet possible and reports two studies, one about thoracic impedence monitoring which has not yet shown to improve {110} and another one that measures pulmonary artery preassure which did reduce hospital admission for HF in one RCT {1}. Nevertheless, more recent studies have revealed that automatic implant-based multiparameter telemonitoring devices are likely to improve clinical outcomes in patients with chronic heart failure (Hindriks et al., 2014; Parthiban et al., 2015). {125} {126} Relatively to remote monitoring without implantable devices to date they have given inconsistent results and not yet support a guideline recommendation {3}.

Other diagnostic factors, such as asymptomatic atrial fibrillation, patient activity, mean resting heart rate, right ventricular pacing percentage, and cardiac resynchronization therapy pacing percentage, might help. Combined heart failure device diagnostics have been demonstrated to improve the identification of patients at a higher risk of subsequent heart failure hospitalizations. Recently, the Implant-based Multiparameter Telemonitoring of Patients with Heart Failure randomized clinical trial demonstrated that daily automatic remote monitoring enabled early action to be taken in response to the warning signs of acute decompensated heart failure (not including thoracic impedance), resulting in lower all-cause mortality and hospital admission rates for heart failure (Slotwiner et al., 2015).

A recent consensus paper recommends all patients with a cardiac implantable electric device should be offered remote monitoring as part of the standard follow-up management strategy.  This implies that all patients with a cardiac implantable electric device will have the recommendation to be followed with remote monitoring, with the possibility of easy implementation of remote monitoring or telemonitoring with telephone support also for heart failure. (Slotwiner et al., 2015).{127}

Pulmonary artery pressure monitoring using a wireless, passive, radiofrequency sensor implanted into a distal branch of the descending pulmonary artery was approved by FDA for implant in NYHA class III HF patients who have been hospitalized for HF in the previous year {33}.

NICE chronic heart failure guidilens {44} given the difficulties of interpretation of the evidence, the GDG did not make specific recommendations for home telemonitoring but agreed that a research recommendation should be made.

The Australian guidelines (National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand) {87} state that all patients hospitalised for heart failure should have post-discharge access to best-practice multidisciplinary chronic HF care that is linked with health services, delivered in acute and subacute healthcare settings and that priority should be given to face-to-face management while the application of remote management assisted by structured telephone support and telemonitoring should be considered for those patients who do not have ready access to a chronic HF management programme (Grade A recommendation).

Important
Partially
Wilbacher I et al. Result Card CUR12 In: Wilbacher I et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 16 June 2021]. Available from: http://corehta.info/ViewCover.aspx?id=305

References