Remote Patient Management for HF and Lower Long-Term Mortality Rates

A remote patient management (RPM) program for heart failure (HF) is not significantly different in time to all-cause death or hospitalization outcomes at 18 and 60 months compared with usual care alone, although a lower mortality rate was observed at 120 months, according to a study in JACC: Heart Failure.

The E-INH (Extended–Interdisciplinary Network Heart Failure) trial evaluated the effects of 18 months of RPM and up to 120 months of follow-up. Participants were aged 18 years or older, were hospitalized with acute cardiac decompensation and clinical signs or symptoms of congestion, and had a left ventricular ejection fraction (LVEF) of 40% or less before discharge. They were randomly assigned 1:1 to HeartNetCare-HF plus usual care (RPM group) or usual care alone (control group).

Centralized follow-up was performed every 6 months. RPM-related procedures were stopped after the 18-month visit, and patients continued medical care with follow-up visits at 36, 60, and 120 months. The primary efficacy outcome was the time to a first event of the composite of all-cause mortality or hospitalization.

A total of 1022 patients (median age, 70 years; 29% women) initiated care in the RPM (n=509) and control (n=513) groups from March 1, 2004, to December 10, 2008. The last patient completed 120 months of follow-up on October 10, 2018.

The rates of all-cause death or hospitalizations were not different in the RPM group compared with the usual care group at 18 months (60.7% [95% CI, 56.5%-65.0%] vs 61.2% [95% CI, 57.0%-65.4%]; hazard ratio [HR], 0.96 [95% CI, 0.82-1.13]; P =.63) or 60 months (78.1% [95% CI, 74.4%-81.6%] vs 82.8% [95% CI, 79.5%-86.0%]; HR, 0.88 [95% CI, 0.77-1.01]; P =.077).

Although all-cause mortality was approximately 20% at 18 months in both groups, fewer patients who had participated in the RPM group had died at 60 months compared with those who had been in the usual care group (41.1% [95% CI, 37.0%-45.5%] vs 47.4% [95% CI, 43.2%-51.8%]; HR, 0.82 [95% CI, 0.68-0.99]; P =.040). This benefit continued through 120 months (64.0% [95% CI, 59.8%-68.2%] vs 69.6% [95% CI, 65.6%-73.5%]); HR, 0.83 [95% CI, 0.72-0.97]; P =.019).

The RPM group had a significantly favorable between-group difference vs the control group regarding the composite of cardiovascular death or hospitalization at 18 and 60 months (22.6% vs 29.1% [P =.032] and 36.2% vs 42.7% [P =.025]). Cardiovascular death rates at 18 months were approximately 12% in both groups. At 60 and 120 months, cardiovascular death rates were lower in the RPM group vs the control group (25.0% vs 30.7%, P =.055; and 33.0% vs 39.8%, P =.043).

The 2 treatment groups had significant improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary scores after hospital discharge. Improvements were significantly greater in patients in the RPM group compared with those who had usual care only throughout. In patients with available follow-up data during the intervention-free period, these benefits continued for up to 120 months.

The investigators noted that analyses are limited to cases with available data regarding KCCQ results and continuous clinical variables, and participants were aware of study arm allocation when completing the KCCQ. In addition, all study centers were from 1 region in Germany, and participants were predominantly Caucasian. Furthermore, standard digital medical technologies and invasive monitoring strategies were not available when HeartNetCare-HF and the E-INH study were developed.

“RPM strategies may decrease the need for in-person attendance at outpatient services and facilitate specialist care for those experiencing barriers to in-person consultations due to physical frailness, shortage of resources, and/or geographical distance, while also helping ensure the safety and health of patients and health care providers in situations such as the recent COVID-19 pandemic,” wrote the researchers.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.