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Telemedicine in heart failure: pre-specified and exploratory subgroup analyses from the TIM-HF trial.

Abstract：

BACKGROUND:Meta-analyses have suggested that remote telemedical management (RTM) positively affects clinical outcomes in chronic HF patients. The results of two recent randomised RTM trials do not corroborate these results. We aim to report prospectively defined and exploratory subgroup analyses for the TIM-HF trial and to identify a patient profile that could potentially benefit from RTM for further investigation in randomised clinical trials. METHODS:In TIM-HF, 710 stable chronic HF patients, in NYHA class II or III with a history of HF decompensation within 2 years previously or a LVEF ≤ 25% were randomly assigned (1:1) to RTM or usual care. The primary outcome was total death and secondary outcomes included days lost due to death or HF hospitalisation and a composite of cardiovascular death and HF hospitalisation. Twelve subgroups were prospectively defined and patient profiling was investigated for the subgroup with a prior history of HF decompensation, an LVEF ≥ 25% and a PHQ-9 score<10. RESULTS:The subgroup treatment effects were significant for total mortality for the PHQ-9 subgroup only (p for interaction<0.027). For the outcome 'number of days lost due to hospitalisation for HF or death', the subgroup treatment effects were significant (p for interaction<0.05) for patients with a prior HF decompensation or an ICD implant or a PHQ score of <10 and for the patient-profiling subgroup. CONCLUSIONS:Telemedicine management may not be appropriate for all HF patients. Future research needs to investigate which HF population may benefit from this intervention.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Koehler F,Winkler S,Schieber M,Sechtem U,Stangl K,Böhm M,de Brouwer S,Perrin E,Baumann G,Gelbrich G,Boll H,Honold M,Koehler K,Kirwan BA,Anker SD

doi

10.1016/j.ijcard.2011.09.007

subject

Has Abstract

pub_date

2012-11-29 00:00:00

pages

143-50

issue

3

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(11)01718-9

journal_volume

161

pub_type

杂志文章,多中心研究,随机对照试验

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