Telemedicine offers early warning system for heart patients
Telemedizin schafft Frühwarnsystem für Herzkranke
In the future, daily transmission of medical records could prevent patients with chronic heart failure from plunging into a life-threatening crisis. An appropriate telemedical early warning system is currently being tested in a large clinical trial, the Fontane study. The director of the study presents the project at the MEDICA EDUCATION CONFERENCE 2016 taking place between November 14 and 17 in Düsseldorf.
In Germany, approximately 200,000 patients live with a weakness of the heart muscle that doctors call chronic heart failure. “Most patients are in stable condition thanks to medications and pacemakers”, says. Professor Dr. med. Friedrich Köhler, Charité University Medical Department Berlin: “However, deterioration can occur at any time. If this is not recognized in time, long hospital stays that are costly for the insurer will be required.”
A looming crisis is frequently signaled by a fall in blood pressure, pulse acceleration or by a weight gain due to water retention in the tissue. “Patients do not feel this initially”, explains Professor Köhler, who manages the Center for Cardiovascular Telemedicine at the Charité. “If a diagnosis is made in the early stages, we are often able to take countermeasures to prevent deterioration or even premature death”.
The option for daily transmission of data to a control center as an appropriate early warning system is currently tested in Germany in a trial known as the Fontane study that includes 1500 patients with chronic heart failure. Half of the patients are provided with a device. The device transmits data on blood pressure, pulse, body weight and other factors on a daily basis. “The aim is to reduce the number of days lost by hospital stays or premature death”, explains Professor Köhler. Whether this will succeed is not yet clear. Initial results from the study should be available in 2018.
Two previous studies have already demonstrated that telemedical monitoring can improve the quality of life and chances of survival of patients with severe heart failure. In both studies, signals were collected from implanted devices. In the CHAMPION study, this was a pressure gauge in the pulmonary artery, while in the IN-TIME study, data from an implanted defibrillator (ICD) were telemedically transmitted to a center. In two additional studies – MORE-Care and REM-HF – remote retrieval of data from pacemakers and ICD systems could not improve the situation of patients. Professor Köhler stresses: “This is why it is always important to check if telemedical monitoring makes sense.” The expert can imagine that telemedicine could help especially people in rural areas to receive medical help in time. Professor Köhler explains: “In Germany, we have differences in care between rural areas and metropolitan regions. This discrepancy must be removed as soon as possible.”
However, telemedicine should not and cannot replace a visit to the doctor. “Telemedical care of patients on its own is forbidden in Germany”, says Professor Köhler. The quality of care must remain unchanged. “The same standards are applied as for a visit to the doctor” promises Professor Köhler. “Treatment of a patient with chronic heart failure must be carried out personally by a specialist based on adequate information and in accordance with the medical confidentiality.” Professor Köhler addresses these requirements for telemedical care as well as the current status of the Fontane study on the theme day “Internal Medicine: Future Technologies and Remote Patient Management“ on November 16, 2016 on the MEDICA EDUCATION CONFERENCE in Düsseldorf. The symposium under his chairmanship will also address telemedical approaches in pregnancy-induced hypertension.
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Results of the CHAMPION Study Abraham WT, Stevenson LW, Bourge RC, Lindenfeld JA, Bauman JG, Adamson PB. Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet. 2016; 387 (10017):453-61.
Results of the IN-TIME Study Hindricks G, Taborsky M, Glikson M, Heinrich U, Schumacher B, Katz A, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014; 384(9943): 583-90
Results of the MORE-CARE Study Boriani G, Da Costa A, Quesada A, Ricci RP, Favale S, Boscolo G, et al. Effects of remote monitoring on clinical outcomes and use of healthcare resources in heart failure patients with biventricular defibrillators: results of the MORE-CARE multicentre randomized controlled trial. European journal of heart failure. 2016; doi: 10.1002/ ejhf.626
Results of the REM-HF Study European Society of Cardiology. The REM-HF trial - Remote Monitoring of implantable cardiac Devices: No added Benefit, press release, 28. August 2016, Roma/Italy