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. 2016 Jan;85(1):53-60.
doi: 10.1016/j.ijmedinf.2015.10.001. Epub 2015 Oct 22.

The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study

Imke Kraai  1 , Arjen de Vries  2 , Karin Vermeulen  3 , Vincent van Deursen  2 , Martje van der Wal  4 , Richard de Jong  5 , René van Dijk  6 , Tiny Jaarsma  4 , Hans Hillege  3 , Ivonne Lesman  3
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Free article

The value of telemonitoring and ICT-guided disease management in heart failure: Results from the IN TOUCH study

Imke Kraai et al. Int J Med Inform. 2016 Jan.
Free article

Abstract

Aim: It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs.

Methods: A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS+telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL).

Results: In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS+telemonitoring (mean difference 0.1, 95% CI: -0.67 +0.82, p=0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS+telemonitoring (p=0.27); HF-readmission 28% vs. 27% p=0.87; all-cause readmission was 49% vs. 51% (p=0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were €1360 in favor of ICT-guided-DMS. ICT-guided-DMS+telemonitoring had significantly fewer HF-outpatient-clinic visits (p<0.01).

Conclusion: ICT-guided-DMS+telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs.

Keywords: Computer decision support; Disease management; Heart failure; ICT-guided disease-management; Telemonitoring.

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