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Medicineworld.org: Individualized treatment for heart failure

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Individualized treatment for heart failure




Telemonitoring systems, by which the symptoms of heart failure can be remotely assessed, now provide a strategy for the improved personalised care of patients, as per Professor John Cleland from the University of Hull, UK.1 He told Heart Failure Congress 2009 that the management of heart failure is complex but most effective when tailored to the individual patients' needs and condition.2 "Unfortunately," he added, "the resources mandatory to offer this tailored therapy outside a hospital setting are generally not available. Current services provide, at best, only a crude attempt to deliver long-term, personalised healthcare, but telemonitoring provides a strategy which could radically change this situation".



Individualized treatment for heart failure

Professor Cleland explained that the first generation of home monitoring devices for heart failure were relatively simple. They were designed to measure symptoms, weight, heart rate and rhythm, and blood pressure. But, he said, "from the patient's perspective, they were relatively unrewarding since the systems provide little in the way of advice or feedback. Nonetheless, a series of randomised controlled trials have shown a reduction in mortality and in days spent in hospital, eventhough not in the rate of hospitalisation."

Ongoing trials of second generation equipment, he continued, reflect the same measure of symptom evaluation but a more interactive experience for the patient. "These newer systems," he explained, "provide education, feedback to patients on their results, therapy and appointment reminders and a limited amount of advice on adjusting treatment. They are likely to deliver even greater health gains than first generation systems".

And now, further generations of telemonitoring systems are being developed, including:
  • Implanted systems ranging form a large pacemaker-like device which simply measures cardiac output and filling pressures, to standard pacemakers and defibrillators with additional telemonitoring capability, to devices that can be implanted percutaneously and don't require batteries. These may or may not be associated with external sensors for measuring weight and blood pressure.
  • Ingested systems as an integral part of the patient's daily treatment.
  • New sensors which can measure heart, lung and vascular function and/or fluid retention more accurately.
  • New systems which empower the patient, allowing them to make their own decisions about their care, with a distant supervisory role for a nurse or doctor. By including voluntary services and informal carers, this can increase rather decrease social inclusion.

However, Professor Cleland added that such a rapid technical evolution has run far ahead of any service evolution, and warned that conventional clinical trials are likely to underestimate the benefits of these new telehealth systems once integrated into an efficient service. Future clinical trials, he said, should ensure service integration and define the "control" intervention: "If service integration is poor or insufficient resources are invested in the control group, then even an effective technology will fail".

A meta-analysis of 14 randomised controlled trials (4264 patients) of remote monitoring observed that programmes for chronic heart failure which included some form of remote monitoring had a positive effect on clinical outcomes in community-dwelling patients with chronic heart failure.3.


Posted by: Daniel    Source




Did you know?
Telemonitoring systems, by which the symptoms of heart failure can be remotely assessed, now provide a strategy for the improved personalised care of patients, as per Professor John Cleland from the University of Hull, UK.1 He told Heart Failure Congress 2009 that the management of heart failure is complex but most effective when tailored to the individual patients' needs and condition.2 "Unfortunately," he added, "the resources mandatory to offer this tailored therapy outside a hospital setting are generally not available. Current services provide, at best, only a crude attempt to deliver long-term, personalised healthcare, but telemonitoring provides a strategy which could radically change this situation".

Medicineworld.org: Individualized treatment for heart failure

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