PMID- 20883060
OWN - NLM
STAT- MEDLINE
DCOM- 20110118
LR  - 20220317
IS  - 1179-1969 (Electronic)
IS  - 1170-229X (Linking)
VI  - 27
IP  - 10
DP  - 2010 Oct 1
TI  - Impact of home patient telemonitoring on use of beta-blockers in congestive heart 
      failure.
PG  - 801-5
LID - 10.2165/11538210-000000000-00000 [doi]
AB  - INTRODUCTION: Congestive heart failure (CHF), which typically affects older 
      people, is characterized by high short- and mid-term mortality rates. However, 
      despite accumulating evidence showing that administration of beta-blockers 
      (beta-adrenoceptor antagonists) can improve the clinical status of CHF patients, use 
      of these agents in adequate dosages in this setting is not routine. One reason 
      for this appears to be a concern about a possible risk of bradyarrhythmia 
      associated with use of beta-blockers. Telecardiology has recently been investigated 
      as a means of constantly monitoring the heart rate of CHF patients in their 
      homes. Its use may allay concerns about the risk of bradyarrhythmia and 
      facilitate a more widespread use of beta-blockers in this context. OBJECTIVES: The 
      primary objectives of this study were to assess the impact of telemonitoring on 
      patients' adherence to prescribed therapeutic regimens, particularly beta-blockers, 
      and to explore whether use of home telemonitoring reduces mortality and rate of 
      re-admission to hospital in elderly CHF patients compared with normal specialized 
      CHF team care. METHODS: A total of 57 patients with CHF (31 New York Heart 
      Association [NYHA] class II, 23 NYHA class III and 3 NYHA class IV), with a 
      mean +/- SD age of 78.2 +/- 7.3 years, were randomized to a control group who 
      received standard care, based on routinely scheduled clinic visits, from a team 
      specialized in CHF patient management, or to a home telemonitoring group (TM 
      group), managed by the same specialized CHF team. Patients were followed up over 
      12 months. RESULTS: Compared with the control group, the TM group had a 
      significant increase in the use of beta-blockers, HMG-CoA reductase inhibitors 
      (statins) and aldosterone receptor antagonists. A reduction in nitrate 
      administration compared with baseline was also seen in the TM group. The 12-month 
      occurrence of the primary combined endpoint of mortality and hospital 
      re-admission for CHF was significantly lower in the TM group than in the control 
      group (p < 0.01). CONCLUSIONS: This study showed that a home-care model including 
      telemonitoring of relevant clinical parameters may provide useful support in the 
      management of patients with CHF. Home telemonitoring in CHF patients was 
      associated with increased use of beta-blockers at appropriate doses, suggesting that 
      this strategy reassured physicians regarding the safety of careful use of these 
      agents in this setting. However, larger studies are required to confirm these 
      findings. Our findings indicate that there is a need to investigate relevant 
      parameters in CHF patients at the point of care (i.e. in patients' daily lives), 
      which can in turn optimize beta-blocker and other drug therapy.
FAU - Antonicelli, Roberto
AU  - Antonicelli R
AD  - U.O. Cardiologia-UTIC e Centro di Telemedicina, Italian National Research Center 
      on Aging (INRCA)-IRCCS, Ancona, Italy. r.antonicelli@inrca.it
FAU - Mazzanti, Ilaria
AU  - Mazzanti I
FAU - Abbatecola, Angela M
AU  - Abbatecola AM
FAU - Parati, Gianfranco
AU  - Parati G
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - New Zealand
TA  - Drugs Aging
JT  - Drugs & aging
JID - 9102074
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/administration & dosage/*therapeutic use
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*drug therapy/mortality
MH  - Humans
MH  - Male
MH  - *Medication Adherence
MH  - *Monitoring, Ambulatory
MH  - Patient Care Team
MH  - Patient Readmission
MH  - *Telemedicine
EDAT- 2010/10/05 06:00
MHDA- 2011/01/19 06:00
CRDT- 2010/10/02 06:00
PHST- 2010/10/02 06:00 [entrez]
PHST- 2010/10/05 06:00 [pubmed]
PHST- 2011/01/19 06:00 [medline]
AID - 3 [pii]
AID - 10.2165/11538210-000000000-00000 [doi]
PST - ppublish
SO  - Drugs Aging. 2010 Oct 1;27(10):801-5. doi: 10.2165/11538210-000000000-00000.