World Congress of Cardiology Report - We have shown that it is possible to care for ill patients affected by heart failure directly from home by controlling their heart rate, fluid retention, blood pressure and weight through new telemedicine techniques.
The study found that both ECG and respiration can be easily recorded at home with a very simple device, and the signals transmitted via normal telephone lines from the home to a referring hospital, and then analyzed off-line. When the heart is damaged (because of previous heart attacks or valvular disease, or because hypertension and diabetes are slowly reducing the pumping ability), respiration becomes fast and very irregular, with frequent episodes of apnoea (pauses in breathing) during the night. These periods of absent respiration during the night produce important decreases of oxygenation of the blood which are known to cause more serious events.
Monitoring respiration and vital signs directly from home improves the quality of care of patients with heart failure, and may avoid long, and sometimes unnecessary, hospitalizations.
The study, known as Home or Hospital in Heart failure - the HHH trial, was conducted in 3 European countries - representing the south (Italy), the east (Poland) and the north (UK). The HHH trial was funded by a grant from European Community (QLGA-CT-2001-02424). We looked at 461 patients affected by heart failure who were in a stable phase of the disease and followed their progress for one year. The usual treatment was given to all patients. Those randomized to participate in telemonitoring were also monitored at home via a special telephone line and a self positioning recorder of ECG and respiration.
This study, the largest so far of these new techniques, demonstrates that self-managed home telemonitoring of both vital signs and respiration is feasible in heart failure patients, and their compliance with this novel method is high - even in older patients who were not used to this type of technology. Particularly, we obtained excellent records of nocturnal respiration - which are those with the greatest clinical relevance. Indeed, it was shown in HHH that prolonged periods of apnoea during night-time are significantly associated with higher morbidity and mortality.
Patients randomized to telemonitoring, (with some differences among countries), tended to have a more favourable outcome, and reduced hospitalizations.
This is an important achievement that will certainly promote the design and implementation of new models for home telemonitoring of physiological signals, which are suitable for self-management by chronically ill patients.
We derived many insights from the study results and experience. We suggest that some aspects of the HHH model could be usefully improved in the future, by exploiting newer technologies, together with better tailoring of the measurements to the real needs of the patients.