Efficacy of a Physician-Led Multiparametric Telemonitoring System in Very Old Adults with Heart Failure

ObjectivesTo evaluate the effect of an innovative model integrating telemonitoring of vital parameters and telephone support on 6-month survival and hospital admissions of elderly adults with heart failure (HF). DesignParallel-arm, randomized trial. SettingGeriatric acute care ward and outpatient clinic at Policlinico Campus Biomedico (Rome, Italy). ParticipantsIndividuals with HF aged 65 and older (mean age 80) randomly assigned to intervention (n=50) or control (n=46). Participants had an average ejection fraction of 46%. InterventionTelemonitoring system (receives and communicates oxygen saturation, heart rate, and blood pressure readings) and office-hours telephonic support provided by a geriatrician. MeasurementsCombination of all-cause death and hospital admissions. ResultsThe two groups were similar with the exception of the prevalence of women and of disability (both more common in the control group). Three patients for each group were lost to follow-up (final analyzed sample size: 90). Incidence of the main outcome was 42% in the control group and 21% in the intervention group (relative risk=0.51, 95% confidence interval (CI) =0.26-0.98). The results were unchanged after taking into account the setting of enrollment, sex, and disability (hazard ratio=0.42, 95% CI=0.19-0.94). ConclusionTelemonitoring of elderly people with HF is feasible and reduces the risk of death and hospitalization. Further studies are needed to confirm these findings and evaluate the cost-efficacy of the service.