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Review
. 2024 Dec 4:26:e63391.
doi: 10.2196/63391.

Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany

Sebastian Spethmann  1   2   3 , Gerhard Hindricks  1   2 , Kerstin Koehler  1   2 , Stefan Stoerk  4 , Christiane E Angermann  5   6 , Michael Böhm  7 , Birgit Assmus  8   9 , Sebastian Winkler  10 , Martin Möckel  2   11 , Mirja Mittermaier  2   12 , Monika Lelgemann  13 , Daniel Reuter  13 , Ralph Bosch  14 , Alexander Albrecht  15 , Stephan von Haehling  16   17 , Thomas M Helms  18   19 , Stefan Sack  20 , Tarek Bekfani  21 , Jan Wolfgang Gröschel  1   22   23 , Magdalena Koehler  24   25 , Christoph Melzer  2 , Jan Wintrich  7 , Bettina Zippel-Schultz  18 , Georg Ertl  6 , Claus Vogelmeier  26 , Nikolaos Dagres  1   2 , Jasmin Zernikow #  1   2 , Friedrich Koehler #  1   2
Affiliations
Review

Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany

Sebastian Spethmann et al. J Med Internet Res. .

Abstract

Background: Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020.

Objective: This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine's integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine.

Methods: We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring.

Results: Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care.

Conclusions: The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF.

Keywords: Europe; e-counseling; heart decompensation; patient care management; telemedicine.

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Conflict of interest statement

Conflicts of Interest: Stefan von Haehling has been a paid consultant for and/or received honoraria payments from AstraZeneca, Bayer, Boehringer Ingelheim, BRAHMS, Chugai, Edwards Lifesciences, Grünenthal, Helsinn, Hexal, Novartis, Novo Nordisk, Pharmacosmos, Respicardia, Roche, Servier, Sorin, and Vifor. S.v.H. reports research support from Amgen, Boehringer Ingelheim, IMI, and the German Center for Cardiovascular Research (DZHK).

Thomas M. Helms does not have a financial interest / arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this paper.

Ralph Bosch received lecture honoraria and consultant remuneration from BIOTRONIK and Medtronic.

Birgit Assmus received speaking and / or consulting fees outside the submitted work from the following companies: Abbot, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS, Edwards, Novartis, NovoNordisk, Pfizer, Vifor CSL, ZOLL.

Friedrich Koehler received research grants from the German Federal Ministry of Education and Research (BMBF) as well as the German Federal Ministry of Economic Affairs and Climate Action (BMWK). He received consultant remuneration from Biotronik.

Figures

Figure 1
Figure 1
Selected types of sensors used in telemonitoring. CIED: cardiac implantable electronic device.
Figure 2
Figure 2
Highlighted trials and randomized controlled trials (RCTs) on telemonitoring from 2009 to present.
Figure 3
Figure 3
Components of telemonitoring in heart failure according to the G-BA (Federal Joint Committee/Gemeinsamer Bundesausschuss) approval in Germany.
See this image and copyright information in PMC

References

    1. Flesche CW, Jalowy A, Inselmann G. Telemedicine in the maritime environment--hightech with a fine tradition. Med Klin (Munich) 2004 Mar 15;99(3):163–8. doi: 10.1007/s00063-004-1026-5. - DOI - PubMed
    1. Setoguchi Soko, Stevenson Lynne Warner, Schneeweiss Sebastian. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J. 2007 Aug;154(2):260–6. doi: 10.1016/j.ahj.2007.01.041.S0002-8703(07)00378-X - DOI - PubMed
    1. Statistisches Bundesamt Diagnosedaten der patienten und patientinnen in krankenhäusern (einschl. sterbe- und stundenfälle) - fachserie 12 reihe 6.2.1 - 2016 (letzte ausgabe - berichtsweise eingestellt) Statistisches Bundesamt. 2016. [2024-06-01]. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Kranken... .
    1. Neumann T, Biermann J, Erbel R, Neumann A, Wasem J, Ertl G. Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspectives. Dtsch Arztebl Int. 2009;106(16):269–75. doi: 10.3238/arztebl.2009.0566. - DOI - PMC - PubMed
    1. Cleland John G F, Louis Amala A, Rigby Alan S, Janssens Uwe, Balk Aggie H M M, TEN-HMS Investigators Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol. 2005 May 17;45(10):1654–64. doi: 10.1016/j.jacc.2005.01.050. https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)00484-5 S0735-1097(05)00484-5 - DOI - PubMed

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