Heart Failure Monitoring With Telemedicine Across eHealth Literacy Boundaries

Telemedicine doctor looking at x-ray
Researchers sought to determine the effectiveness of telemedicine-based management in patients with heart failure and varying eHealth literacy levels and skills.

Among patients with heart failure (HF) following recent discharge from the hospital, managed care through telemedicine proved effective compared with usual care regardless of patient educational level or computer or digital literacy level, according to study results published in the European Journal of Internal Medicine.  

Researchers sought to assess the effectiveness of telemedicine across patient literacy and communications technology (ICT) skill levels. To accomplish this, they conducted a subanalysis of the Heart Failure Remote Optimization (iCOR) study (ClinicalTrials.gov Identifier: NCT01495078), a randomized, controlled, single-center proof-of-concept clinical trial to evaluate the efficacy of adding telemedicine to existing usual care in patients with HF following recent hospital discharge. A nonfatal heart event within 6 months of discharge from the hospital was the primary endpoint. HF event rates were analyzed across literacy domains using regression models. Lower literacy among patients was defined as 12 years or less of formal education. Middle or higher literacy was defined by more than 12 years of formal education. To determine ITC literacy, patients self-evaluated on a scale of 1 (no difficulty handling ICT devices) to 5 (maximum difficulty) and those self-described scoring 3 to 5 were considered lower ITC literacy. Those self-reporting 1 or 2 were considered as having middle or higher ICT skills.

The lower literacy contingent included 126 patients (aged 76±10 years; 51% women) of whom 45% received telemedicine. The middle or higher literacy contingent included 52 patients (aged 70±14 years; 17% women) of whom 46% received telemedicine. Hypertension was the most common comorbidity (88%).

Telemedicine vs usual care was helpful for traditional and computer literacy subgroups (P =.207 and P =.117, respectively). Lower risk for HF primary events was seen in patients experiencing telemedicine compared to usual care in patients with lower literacy (P =.001) and patients with lower ICT skills (P =.001).

Study limitations included the poor ability to assess long-term death rates, only including 2 of the 6 eHealth literacy domains, self-evaluation of ICT skills, the unbalance of women represented in the higher literacy cohort, and the single-center sub-analysis.

The study authors wrote, “Noninvasive eHealth-based HF monitoring tools are effective compared to [usual care] in preventing HF events in the early postdischarge period, regardless of 2 ‘eHealth literacy’ domains (‘traditional and computer literacy’).”


Yun S, Enjuanes C, Calero-Molina E, et al. Usefulness of telemedicine-based heart failure monitoring according to ‘eHealth literacy’ domains: Insights from the iCOR randomized controlled trial. Eur J Intern Med. Published online April 25, 2022. doi:10.1016/j.ejim.2022.04.008