blood pressure, heart rate, weight and oxygen saturation (often supplemented by automated questions on a variety of symptoms). Standalone devices for use at home which can measure, e.g.Structured telephone support for patients from the HF team, typically provided by HF specialist nurses as part of a disease management programme or a post-discharge service.Telemonitoring or RM encompasses the use of audio, video and other telecommunication technologies to monitor patient status at a distance. This article briefly discusses a variety of telemonitoring approaches that have been used in HF management, and the evidence for their impact. Medical guideline writers are sceptical and are lukewarm in their current recommendations ( Table 1), on the basis that there is a lack of large-scale, randomised trials that show a consistent effect of the introduction of remote monitoring (RM). The field is rapidly changing, as are the technologies that can be used, and regulators, reimbursement authorities and healthcare professionals often struggle to assess the value of the technologies. Policy-makers and technology companies are enthusiastic about the potential of digital technologies to transform the healthcare system into a more personalised, responsive and effective process that brings the expertise to the patient, rather than the other way round. It is not difficult to collect data remotely, but it has been a challenge to find a way to integrate such potentially continuous data streams into systems of care, and to convert more data into better decision-making that improves the outcome or experience of care. Simple, telephone-call based, remote assessment by a HF nurse specialist, standalone home-based systems, implanted devices (such as cardiac resynchronisation therapy and ICDs) and now wearable technologies have opened up a world of possibilities. Technological advances in the past three decades have allowed increasingly sophisticated attempts to remotely monitor and manage the HF syndrome. 8–10 The hope is that more intensive monitoring in the community can identify decompensation early, support adherence to lifestyle and medication, and prompt intervention (such as changes to diuretic dosage) in those who are no longer euvolaemic. International guidelines recommend disease management programmes with education and support for individuals and families who wish to become more skilled in self-monitoring and management. Much attention has focused on identifying decompensation of the HF syndrome before there is a need for emergency hospital admission. 6 In the US, projections suggest that, by 2030, the total cost of HF will increase by almost 130% to US$70 billion annually. In European and North American countries, approximately 2% of the healthcare budget is spent on HF. 5 Length of stay varies between 7 and 11 days in most developed countries, and the overall economic impact on health budgets is therefore substantial. 4 In-hospital mortality is in the range of 5–10% in most series, and emergency readmission within 1 month is as high as 25% in some studies. 2,3įrailty is common and, even when HF is diagnosed in the community, almost 10% of patients are admitted as an emergency with worsening symptoms within 1 year. 1 Comorbidity is the rule, with half of hospitalised patients having at least five comorbidities. Prevalence increases steeply with age, and the average age of a person admitted to hospital with decompensation in developed countries such as the UK is in the high 70s. Heart failure (HF) is increasing in prevalence globally, and is associated with considerable ill health, healthcare costs and mortality.
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