Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study

Circulation. 2011 May 3;123(17):1873-80. doi: 10.1161/CIRCULATIONAHA.111.018473. Epub 2011 Mar 28.


Background: This study was designed to determine whether physician-led remote telemedical management (RTM) compared with usual care would result in reduced mortality in ambulatory patients with chronic heart failure (HF).

Methods and results: We enrolled 710 stable chronic HF patients in New York Heart Association functional class II or III with a left ventricular ejection fraction ≤35% and a history of HF decompensation within the previous 2 years or with a left ventricular ejection fraction ≤25%. Patients were randomly assigned (1:1) to RTM or usual care. Remote telemedical management used portable devices for ECG, blood pressure, and body weight measurements connected to a personal digital assistant that sent automated encrypted transmission via cell phones to the telemedical centers. The primary end point was death from any cause. The first secondary end point was a composite of cardiovascular death and hospitalization for HF. Baseline characteristics were similar between the RTM (n=354) and control (n=356) groups. Of the patients assigned to RTM, 287 (81%) were at least 70% compliant with daily data transfers and no break for >30 days (except during hospitalizations). The median follow-up was 26 months (minimum 12), and was 99.9% complete. Compared with usual care, RTM had no significant effect on all-cause mortality (hazard ratio, 0.97; 95% confidence interval, 0.67 to 1.41; P=0.87) or on cardiovascular death or HF hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.67 to 1.19; P=0.44).

Conclusions: In ambulatory patients with chronic HF, RTM compared with usual care was not associated with a reduction in all-cause mortality.

Clinical trial registration: URL: Unique identifier: NCT00543881.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care / methods*
  • Blood Pressure
  • Body Weight
  • Computers, Handheld
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis
  • Heart Failure / mortality*
  • Heart Failure / therapy*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Managed Care Programs / statistics & numerical data
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data
  • Quality of Life
  • Telemedicine / methods*

Associated data