Application Study Of Remote Telemonitoring In Management Of Out-patients With Chronic Heart Failure

Objective:To determine the outpatient follow-up,telephone intervention,combined with remote telemonitoring management model on the prognosis of patients with chronic heart failure.Method:We enrolled patients with stable chronic heart failure and LVEF<45%,except of the patients with ICD or CRT,collected their clinical data and general demographic data before when they are in hospital,include age,gender,heart rate,6MWD,KCCQ and so on.With pharmacological treatment to control heart failure and dyslipidemia,β-blocker therapy should be started from a small dosage to the target dosage gradually.Heart rate control target is:resting heart rate 55-60bpm in sinus patients;atrial fibrillation patients resting less than 80bpm,less than 110bpm after the event,when necessary to use digoxin.At the time of discharge,the symptoms of heart failure were well controlled and the condition was stable.Patients are random assigned to the remote telemonitoring management group and no telemonitoring group,the data collection was carried out at 12 months,the outpatient follow-up:By the cardiologist to responsible for the first 1,3,6,9,12 months after discharge outpatient follow-up;telephone intervention:After the first month of discharge once a week,the first 2,3 months every 2 weeks,after once a month,each time about 10 minutes.Both of group use the outpatient follow-up and telephone intervention.the different is the remote group use the remote telemonitoring to monitoring heart rate,three times one day,divided into rest and after the activities.Immediate transmission of ECG if uncomfortable.In the group of no telemonitoring,the patients choose to do electrocardiogram examination in conditional circumstances.After 12 months of follow-up,the KCCQ score,heart rate,LVEF,LVEDD,6 min walking distance,and rehospitalization were evaluated.Quantitative data were used to describe the mean and standard deviation.The comparison between the two groups was based on the independent t test.The paired t test was used in the group.The qualitative data were used to describe the number and the percentage.The chi-square test or the Fisher exact probability method were used.All statistical analysis was performed using SPSS statistical software,P<0.05 that the difference was statistically significant.Results:A total of 74 patients were followed up management and data collection,including 36 cases of the remote management group(experimental group)and 38 cases of the conventional management group(control group).Two groups of age,gender,New York cardiac function classification,KCCQ score,6 min walking distance,heart rate level baseline level is consistent.The CHF patients were followed up for 12 months.1,There was a significant difference in heart rate control between the two groups(P = 0.00 in patients with sinus rhythm and P = 0.00 for atrial fibrillation).There was a significant difference in heart rate control between the general management group and 1 year after follow-up(P = 0.00 in patients with sinus rhythm and P = 0.027 for atrial fibrillation).There was a significant difference in heart rate control between the remote management group and the general management group(P=0.00 in patients with sinus rhythm and P = 0.032 for atrial fibrillation).There was significant difference between the remote management group and the general management group(P = 0.00).The remote management group can more effectively detect arrhythmias compared to the general management group.2,At the end of 12 months follow-up,KCCQ score,6 min walking distance,LVEF and LVEDD were improved in the remote management group and the difference was statistically significant(P = 0.00).In general management group,the KCCQ score was improved after 12 months of follow-up,and the 6-minute walking distance was improved from the time of enrollment(P = 0.031,P = 0.041).but there was no significant difference between LVEF and LVEDD(P = 0.590,P = 0.285).The difference of KCCQ score,6 min walking distance,LVEF and LVEDD was statistically significant between the two groups(P = 0.00,P = 0.003,P = 0.042,P =0.021).3,Drug adjustment:The main adjustment drug in the period of management is.the diuretics and P-blockers,the emergence of liquid retention in time to adjust diuretics,and gradually adjust the β-blockers to achieve maximum Tolerant dose.There were significant differences in the drug adjustment between the remote management group and the general management group(P<0.05).4,In 12 months,There were four patients in the remote managemnent group were re-hospitalized for heart failure.There were 6 patients in the general management group were re-hospitalized.There was no significant difference between the two groups(P = 0.190),no death cases.Conclusion:The application of remote telemonitoring in out-hospital management of CHF patients is helpful to heart rate control,increase the detection of arrhythmia,guide the adjustment of heart failure drugs,improve the walking distance of 6 minutes,increase the quality of life score,improve LVEF.