Result card

  • TEC7: Are the reference values or cut-off points clearly established?
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Are the reference values or cut-off points clearly established?

Authors: Ingrid Wilbacher, Valentina Prevolnik Rupel

Internal reviewers: Alessandra LoScalco, Antonio Migliore, Christina Mototolea, Silvia Gabriela Scintee

Five studies  provided an overview of reference measurements in a more detailed way than „guideline conformity“: {27},{20},{26},{15},{29}

The reference values for heart failure diagnostic (- monitoring) are mainly a) mortality and b) hospitalisation (rate).

 

The reference values used for telemedical approaches with structured interviews are more or less standardized (like in www. klinik.uni-wuerzburg.de/medizin1/inh-heartnetcarehf { Rec #: 200}, but there is also a subjective category which cannot be clear established, like „listening into a patients‘ kind of reporting“, „detecting differences within a known patient“, that require a human sense approach.

The reference value of „mortality“ and „hospitalisation“ requires a competent listening/ monitoring person who decides when the emergency chain has to be initiated.

The accuracy for detection of alerts depends on the predefined algorithm within the telemonitoring tool or process. {20}. Several indicators to identify patients at risk of worsening heart failure are available and combined differently, like weight, blood pressure, quality of life, patient activity, increase in pacing tresholds, increase in the percentage of right ventricular pacing, decrease in the left ventricular pacing, artrial and ventricluar tachyarrythmia, thoracic impedance, heart rate variability, respiratory rate.  Commercially available methods include assessment of weight as well as intrathoracic impedance. {1}. Speed of weight gain is more sensitive and specific for heart failure decompensation than absolute weight change, with an increase of more than 2 kg over a period of 72 hours being considered clinically significant. Despite the widespread use of weight monitoring, its accuracy is limited. A weight gain of greater than 2 kg over 48-72 h has good specificity but poor sensitivity for predicting clinical deterioration. In case of weight change all the other symptoms and physiological measurements have to be taken into account to reflect the overall heart failure status. Arrhythmia is common in patients with heart failure, but adding a single-lead ECG monitoring to external monitoring equipment increases the complexity of monitoring without evidence of additional benefit.“ {15}.

Currently available diagnostics provide valuable data in patient evaluation and enable physicians to identify those patients at greater risk of heart failure decompensation, but they have not yet been shown to impact patient outcomes and are often not sufficiently accurate for therapy adjustment. Effective adjustment of medical therapy relies on an accurate assessment of several parameters and involves in person care, telehomecare, and the emerging intervention of telemedicine or remote monitoring. Telemonitoring of basic physiological parameters did not reach the expectations now. {27}

There is a need for individual baselines and for using trend and multiple signals. Most current TM systems use simple thresholds as the basis for triggering an alert that are barely adequate as the basis for reliable triggering. {29}.

Important
Completely
Wilbacher I, Rupel V Result Card TEC7 In: Wilbacher I, Rupel V Description and technical characteristics of 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