Is telemonitoring a good idea for advanced heart failure?

The option of having your health status monitored from home is a relatively new development. It is known as “telemonitoring.” Various health parameters are measured at home and regularly sent to a telemedicine center by computer, tablet or smartphone. The aim is to spot abnormalities early and then be able to react right away – quicker than would be possible with regular doctor’s appointments. For instance, the data can be used to arrange examinations, adjust medication doses or call an ambulance in an emergency.

There are two main types of telemonitoring:

• Self-measurement: Patients are given training in things like how to weigh themselves, measure their blood pressure, do an ECG or assess their general state of health, and then send their electronic health data to the telemedicine center. No special technical skills are needed.
• Automated measurement and transfer: This is only possible for people with advanced heart failure who have an implanted device such as a defibrillator. When needed, defibrillators send electrical signals that return the heart’s rhythm. Some models are also suitable for fully-automated telemonitoring where the health data is forwarded to a telemedicine center without the patient having to do anything themselves.

In Germany, the costs for telemonitoring are covered for advanced heart failure if the heart failure has reached a certain level of severity and has been treated at a hospital. The telemonitoring also has to meet certain conditions.

Researchers at the Institute for Quality and Efficiency in Health Care (IQWiG) assessed the pros and cons of intensive telemonitoring in advanced heart failure. They analyzed the results of four studies with a total of over 3,000 participants. Most of them were male, at least 65 years old, and they had impaired physical fitness. The studies lasted for one or two years.

One half of the participants were given conventional treatment by their doctor, and the other half were also monitored with telemonitoring. The studies compared the two groups. The collection of health data was fully automatic in two of the studies, and the participants measured it on their own in the other two.

Only studies that looked into intensive telemonitoring were included. A number of minimum requirements had to be met for the telemonitoring to classify as intensive:

• At a minimum heart rate and rhythm were measured, general state of health was assessed, or physical activity was tracked during telemonitoring.
• The health data was sent to a telemedicine center on a daily basis.
• The health data was evaluated in the center by in-house specialists.
• The center and the doctor’s office reacted quickly to abnormal health data, e.g. within 24 hours.

The analysis of the studies makes it possible to draw some preliminary conclusions: According to the studies, people with advanced heart failure who were monitored with intensive telemonitoring died less often of a cardiovascular disease.

One exception was if self-measurement was used for the intensive telemonitoring. The two studies that examined this more active type of telemonitoring over a period of one to two years suggest that telemonitoring increases chances of survival, but only for people without signs of depression.

• Without telemonitoring, about 14 out of 100 people died.
• With telemonitoring, about 10 out of 100 people died.

More recent evaluations of studies also found that telemonitoring can increase life expectancy. The use of telemonitoring can also mean that people with heart failure may have to go to the hospital less often because of their condition.

In these studies, telemonitoring had no overall effect on the typical symptoms of heart failure, on strokes, or on severe heart rhythm disorders. In participants with a defibrillator, there was also no difference in the number of electrical signals that the device had to send out to restore the heart rhythm.

It was not possible to evaluate the side effects of telemonitoring based on these studies. Some suitable data on the influence on state of health and quality of life was missing as well.