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      Potential role for clinical calibration to increase engagement with and application of home telemonitoring: a report from the HeartCycle programme

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          Abstract

          Aims

          There is a need for alternative strategies that might avoid recurrent admissions in patients with heart failure. home telemonitoring (HTM) to monitor patient's symptoms from a distance may be useful. This study attempts to assess changes in HTM vital signs in response to daily life activities (variations in medication, salt intake, exercise, and stress) and to establish which variations affect weight, blood pressure, and heart rate.

          Methods and results

          We assessed 76 patients with heart failure (mean age 76 ± 10.8 years, 75% male, mainly in NYHA class II/III and from ischaemic aetiology cause). Patients were given a calendar of interventions scheduling activities approximately twice a week before measuring their vital signs. Eating salty food or a large meal were the activities that had a significant impact on weight gain (+0.3 kg; P < 0.001 and P = 0.006, respectively). Exercise and skipping a dose of medication other than diuretics increased heart rate (+3 bpm, P = 0.001 and almost +2 bpm, P = 0.016, respectively).

          Conclusions

          Our HTM system was able to detect small changes in vital signs related to these activities. Further studies should assess if providing such a schedule of activities might be useful for patient education and could improve long‐term adherence to recommended lifestyle changes.

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          Most cited references4

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          The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis.

          The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management. The survey screened consecutive deaths and discharges during 2000-2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure. A total of 46788 deaths and discharges were screened from which 11327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been measured in 57% of men and 41% of women, usually by echocardiography (84%) and was <40% in 51% of men but only in 28% of women. Forty-five percent of women and 22% of men were reported to have normal left ventricular systolic function by qualitative echocardiographic assessment. A substantial proportion of patients had alternative explanations for heart failure other than left ventricular systolic or diastolic dysfunction, including valve disease. Within 12 weeks of discharge, 24% of patients had been readmitted. A total of 1408 of 10434 (13.5%) patients died between admission and 12 weeks follow-up. Known or suspected heart failure comprises a large proportion of admissions to medical wards and such patients are at high risk of early readmission and death. Many of the basic investigations recommended by the ESC were usually carried out, although it is not clear whether this was by design or part of a general routine for all patients being admitted regardless of diagnosis. The investigation most specific for patients with suspected heart failure (echocardiography) was performed less frequently, suggesting that the diagnosis of heart failure is still relatively neglected. Most men but a minority of women who underwent investigation of cardiac function had evidence of moderate or severe left ventricular dysfunction, the main target of current advances in the treatment of heart failure. Considerable diagnostic uncertainty remains for many patients with suspected heart failure, even after echocardiography, which must be resolved in order to target existing and new therapies and services effectively.
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            Demographics, clinical characteristics, and outcomes of patients hospitalized for decompensated heart failure: observations from the IMPACT-HF registry.

            Hospitalizations for decompensated heart failure are frequent. The Initiation Management Pre-discharge Assessment of Carvedilol Heart Failure (IMPACT-HF) registry collected observational data in patients hospitalized for worsening heart failure to characterize an unselected group of patients and to confirm the generalizability of the IMPACT-HF main trial population. The IMPACT-HF registry was conducted concurrently with the IMPACT-HF study, a randomized trial of in-hospital initiation of carvedilol compared with the standard practice of postdischarge beta-blocker initiation. Patients were eligible for registry enrollment if they were hospitalized for heart failure regardless of ejection fraction. There were no exclusions to participation. Patients were followed for 60 days. The IMPACT-HF Registry enrolled 567 patients. The mean age was 71 years, 52% of the patients were men and 82% were Caucasian. At discharge, 71% received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 41% received digoxin, and 62% received beta-blockers. The 60-day rate of rehospitalization or death was 31%. The IMPACT-HF registry enrolled elderly patients admitted for worsening heart failure primarily resulting from progressive volume overload. The 60-day rate of death or rehospitalization was high despite the use of evidence-based therapies. New treatments for this population are needed to decrease the morbidity and mortality associated with decompensated heart failure.
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              Telemonitoring in heart failure: Big Brother watching over you.

              Heart failure (HF) is a leading cause of hospitalisations in older people. Several strategies, supported by novel technologies, are now available to monitor patients' health from a distance. Although studies have suggested that remote monitoring may reduce HF hospitalisations and mortality, the study of different patient populations, the use of different monitoring technologies and the use of different endpoints limit the generalisability of the results of the clinical trials reported, so far. In this review, we discuss the existing home monitoring modalities, relevant trials and focus on future directions for telemonitoring.
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                Author and article information

                Contributors
                abayesgenis@gmail.com
                Journal
                ESC Heart Fail
                ESC Heart Fail
                10.1002/(ISSN)2055-5822
                EHF2
                Esc Heart Failure
                John Wiley and Sons Inc. (Hoboken )
                2055-5822
                28 July 2016
                February 2017
                : 4
                : 1 ( doiID: 10.1002/ehf2.v4.1 )
                : 66-70
                Affiliations
                [ 1 ] ICREC Research ProgramFundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP) BadalonaSpain
                [ 2 ] Cardiology ServiceHospital Universitari Germans Trias i Pujol BadalonaSpain
                [ 3 ] Department of MedicineUniversitat Autònoma de Barcelona BarcelonaSpain
                [ 4 ]Philips Research EindhovenThe Netherlands
                [ 5 ] National Heart and Lung InstituteHarefield Hospital, Imperial College LondonUK
                [ 6 ]Heidelberg University Hospital HeidelbergGermany
                Author notes
                [*] [* ] Correspondence to: Antoni Bayes‐Genis, Chief of the Cardiology Service, Department of Medicine, UAB, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n 08916 Badalona, Spain. Tel: +34 934978915; Fax: +34 934978939.

                Email: abayesgenis@ 123456gmail.com

                Article
                EHF212104 ESCHF-16-00034
                10.1002/ehf2.12104
                5292630
                28217314
                ecf7c14e-89ad-434a-b82b-c4ad176c04cc
                © 2016 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 01 April 2016
                : 14 June 2016
                : 21 June 2016
                Page count
                Figures: 2, Tables: 1, Pages: 5, Words: 1614
                Funding
                Funded by: EU 7th Frame Programme
                Award ID: FP7‐216695
                Funded by: Redes Temáticas de Investigación Cooperativa en Salud (RETICS)
                Award ID: RD12/0042/0047
                Award ID: RD12/0019/0029
                Funded by: Ministerio de Economía y Competitividad
                Award ID: JCI‐2012‐14025
                Categories
                Short Communication
                Short Communication
                Custom metadata
                2.0
                ehf212104
                February 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.4 mode:remove_FC converted:06.02.2017

                heart failure,self‐management,telemonitoring
                heart failure, self‐management, telemonitoring

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