PMID- 34182596 OWN - NLM STAT- MEDLINE DCOM- 20211028 LR - 20211028 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 8 IP - 5 DP - 2021 Oct TI - Is 24/7 remote patient management in heart failure necessary? Results of the telemedical emergency service used in the TIM-HF and in the TIM-HF2 trials. PG - 3613-3620 LID - 10.1002/ehf2.13413 [doi] AB - AIMS: Telemedical emergency services for heart failure (HF) patients are usually provided during business hours. However, many emergencies occur outside of business hours. This study evaluates if a 24/7 telemedical emergency service is needed for the remote management of high-risk HF patients. METHODS AND RESULTS: The study included 1119 patients merged from the TIM-HF and TIM-HF2 trials [age 69 +/- 11, 73% male, left ventricular ejection fraction 37% +/- 13, 557 New York Heart Association (NYHA) II/562 NYHA III]. Patients received a 24/7 physician-guided emergency service provided by the telemedical centre (TMC) in addition to remote management within business hours. During emergency calls, patient status, symptoms, electronic patient record, and instant telemonitoring data were evaluated by the TMC physician. Following diagnosis, patients were referred for hospital admission or instructed to stay at home. Apart from the TMC, patients could place a call to the public emergency service at any time. Seven hundred sixty-eight emergency calls were placed over 1383 patient years (0.56 calls/patient year). Five hundred twenty-six calls (69%) occurred outside business hours. There were 146 (19%) emergency calls for worsening HF, 297 (39%) other cardiovascular, and 325 (42%) non-cardiac causes, with a similar pattern inside and outside business hours. Of the 1119 patients, 417 (37%) placed at least one emergency call. Patients with NYHA Class III, higher N-terminal prohormone of brain natriuretic peptide (>1.400 pg/mL) levels, ischaemic aetiology of HF, implanted defibrillator, and impaired renal function had a higher probability of placing emergency calls. During study follow-up, patients who made an emergency call had a higher all-cause mortality (22% vs. 11%, P = 0.007 in TIM-HF; 16% vs. 4%, P < 0.001 in TIM-HF2) and more unplanned hospitalizations (324 vs. 162, P < 0.001 in TIM-HF; 545 vs. 180, P < 0.001 in TIM-HF2). Of the total 1,211 unplanned hospital admissions, 492 (41%) were initiated by a patient emergency call. Three hundred seventy-nine calls (49%) were placed to the TMC, whereas 389 calls (51%) were made to the public emergency service. Three hundred twenty-six (84%) of the calls to the public emergency service resulted in acute hospitalizations. The TMC initiated 202 (53%) hospital admissions; 177 (47%) patients were advised to stay at home. All patients that remained at home were alive during a prespecified safety period of 7 days post-call. Diagnoses made by the TMC physician were confirmed in 83% of cases by the hospital. CONCLUSION: A telemedical emergency service for high-risk HF patients is safe and should operate 24/7 to reduce unplanned hospitalizations. Emergency calls could be considered as a marker for higher morbidity and mortality. CI - (c) 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Winkler, Sebastian AU - Winkler S AD - Department of Internal Medicine, Unfallkrankenhaus Berlin, Berlin, Germany. AD - Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charite-Universitatsmedizin Berlin, Chariteplatz 1, Berlin, D-10117, Germany. FAU - Koehler, Kerstin AU - Koehler K AD - Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charite-Universitatsmedizin Berlin, Chariteplatz 1, Berlin, D-10117, Germany. FAU - Prescher, Sandra AU - Prescher S AD - Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charite-Universitatsmedizin Berlin, Chariteplatz 1, Berlin, D-10117, Germany. FAU - Koehler, Magdalena AU - Koehler M AD - Ludwig-Maximilians Universitat Munchen, Munich, Germany. AD - Department of Prevention, Rehabilitation and Sports Medicine, University Hospital 'Klinikum rechts der Isar', School of Medicine, Technical University Munich, Munich, Germany. FAU - Kirwan, Bridget-Anne AU - Kirwan BA AD - Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland; Faculty of Epidemiology and Public Health London School of Hygiene & Tropical Medicine, University College London, London, UK. FAU - Tajsic, Milos AU - Tajsic M AD - Emergency Department, Wilhelminenspital Wien, Vienna, Austria. FAU - Koehler, Friedrich AU - Koehler F AD - Medical Department, Division of Cardiology and Angiology, Centre for cardiovascular Telemedicine, Charite-Universitatsmedizin Berlin, Chariteplatz 1, Berlin, D-10117, Germany. AD - German Centre for Cardiovascular Research Partner Site Berlin, Charite - Universitatsmedizin Berlin, Berlin, Germany. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210628 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM MH - Aged MH - Aged, 80 and over MH - Female MH - *Heart Failure/therapy MH - Hospitalization MH - Humans MH - Male MH - Middle Aged MH - Stroke Volume MH - *Telemedicine MH - Ventricular Function, Left PMC - PMC8497196 OTO - NOTNLM OT - Electrocardiogram OT - Emergency OT - Heart failure OT - Remote patient management OT - Telemonitoring COIS- F. K. reports grants from the German Federal Ministry of Education and Research and grants from Federal Ministry of Economic Affairs and Energy for conducting the clinical trials. He reports personal fees for advisory board from Abbott and personal fees for lectures from Boston Scientific, Sanofi-Aventis Deutschland GmbH, Novartis, Linde/Saude, Roche Pharma AG, Amgen GmbH, and Astra Zeneca outside the submitted work. Further, he is a member of the Commission Digital Health of the German Association for Internal Medicine (DGIM). All other authors have nothing to declare. EDAT- 2021/06/29 06:00 MHDA- 2021/10/29 06:00 PMCR- 2021/06/28 CRDT- 2021/06/28 20:34 PHST- 2021/04/27 00:00 [revised] PHST- 2021/04/11 00:00 [received] PHST- 2021/04/30 00:00 [accepted] PHST- 2021/06/29 06:00 [pubmed] PHST- 2021/10/29 06:00 [medline] PHST- 2021/06/28 20:34 [entrez] PHST- 2021/06/28 00:00 [pmc-release] AID - EHF213413 [pii] AID - 10.1002/ehf2.13413 [doi] PST - ppublish SO - ESC Heart Fail. 2021 Oct;8(5):3613-3620. doi: 10.1002/ehf2.13413. Epub 2021 Jun 28.