Heart Failure (HF) is the leading cause of hospitalization in older people and health costs are increasing. We sought to identify whether HTM improves therapies outcomes for patients with diastolic HF who are at high risk of hospitalization and death.Design and method:
We studied for 1 year patients with a recent clinical admission for HF with preserved left ventricular ejection fraction (LVEF). Patients sent and received data via internet with telematic support. HTM consisted of 6 months weekly remote monitoring of vital signs, blood pressure and ECG, with feed-back instructions for the management of drug therapy and quality way of life.Results:
We enrolled 30 patients from 55 to 90 years (mean 73.7, median 74, mode 61), males (66%), females (34%). The aetiology of diastolic heart disease was: hypertension (68%), post-ischemic (21%), post-myocardial inflammation (6%), post-ischemic associated with immunologic disease (5%). Mean LVEF at the beginning was 50.3% and after 6 months became 54.9%. The rate of mortality at 6 months was extremely low (5%) and the rate of hospitalization too (26%). Considering titration, beta blockers use increases from 67% to 88%, ACEi from 60% to 69%, AT1 from 47% to 80% and Diuretics from 90% to 98%. The rate of mortality at 6 months was extremely low (6%). With HTM patients in NYHA Class IV underwent: 48% in III, 37% in II-III, 5% in II and 5% remained stable in IV; patients in NYHA Class III became II (18%), II-III (18%) and 64 % remained stable. We also observed after 1 ys a significant increase in home blood pressure control (MAP 150 ± 30 mmHg vs 135 ± 15.5 mmHg, p < 0.001).Conclusions:
The results of this study support the compliance and effectiveness a of HTM for the management of diastolic HF in the early months after heart failure admission. In particular we obtained a successful optimization of the therapy according to Guidelines, a significant increase in LVEF, sensible decrease in III-IV NYHA patients and improvement in blood pressure control.