Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial
Open accessAbstract
BACKGROUND: Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients' compliance with self-care, although the results are still contradictory. OBJECTIVE: A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. METHODS: HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients' clinical status, use of health care resources, adherence, and user experience from the patients' and the health care professionals' perspective were studied. RESULTS: Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients' clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. CONCLUSIONS: Home telemonitoring did not reduce the number of patients' HF-related hospital days and did not improve the patients' clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. TRIAL REGISTRATION: Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z).
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Vuorinen et al. found that patients in the telemonitoring intervention group had an increased number of telephone contacts initiated by nurses (IRR = 5.6; 95% CI, 3.41-7.63; P < 0.001).
“However, patients in the telemonitoring intervention group used more healthcare resources; increased number of visits to the nurse (IRR = 1.73; 95% CI, 1.38–2.15; P < 0.001), more time spent with nurses (mean difference = 48.7 min, P < 0.001), and increased number of telephone contacts initiated by nurses (IRR = 5.6; 95% CI, 3.41–7.63; P < 0.001).”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [33]
Five trials did not present details of randomization.
“Considering the method of randomization, 5 trials did not present details of randomization [25, 27, 29, 30, 33].”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [33]
Vuorinen et al. found no difference in the number of HF-related hospital days (IRR = 0.812, P = 0.351).
“In Finland, Vuorinen et al. [33] found no difference in the number of HF-related hospital days (incidence rate ratio, IRR = 0.812, P = 0.351).”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [33]
Vuorinen et al. found that patients in the telemonitoring intervention group spent more time with nurses (mean difference = 48.7 min, P < 0.001).
“However, patients in the telemonitoring intervention group used more healthcare resources; increased number of visits to the nurse (IRR = 1.73; 95% CI, 1.38–2.15; P < 0.001), more time spent with nurses (mean difference = 48.7 min, P < 0.001), and increased number of telephone contacts initiated by nurses (IRR = 5.6; 95% CI, 3.41–7.63; P < 0.001).”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [33]
Vuorinen et al. found that patients in the telemonitoring intervention group had an increased number of visits to the nurse (IRR = 1.73; 95% CI, 1.38-2.15; P < 0.001).
“However, patients in the telemonitoring intervention group used more healthcare resources; increased number of visits to the nurse (IRR = 1.73; 95% CI, 1.38–2.15; P < 0.001), more time spent with nurses (mean difference = 48.7 min, P < 0.001), and increased number of telephone contacts initiated by nurses (IRR = 5.6; 95% CI, 3.41–7.63; P < 0.001).”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [33]
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- Authors
- Vuorinen, A.-L., Leppänen, J., Kaijanranta, H., Kulju, M., Heliö, T., van Gils, M., & Lähteenmäki, J.
- Affiliations
- VTT Technical Research Centre of Finland (FI)
- Helsinki University Hospital (FI)
- Corresponding author
- Vuorinen, Anna-Leena
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2014-12-11
- Volume
- 16
- Issue
- 12
- Pages
- e282
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4275484
- OpenAlex
- W2049660507
- Cited by
- 128
- References
- 32
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 14 · 2023: 13 · 2022: 16 · 2021: 16 · 2020: 12 · 2019: 8 · 2018: 13 · 2017: 6 · 2016: 7 · 2015: 7
- FWCI
- 4.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- Teknologian Tutkimuskeskus VTT
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- heart failure, home health monitoring, multidisciplinary care, heart failure hospitalization, self-care adherence, mobile phone app, nurse follow-up, health care utilization, patient experience, left ventricular ejection fraction, technology acceptance, hospital readmission prevention, user experience, health care costs, provider satisfaction, patient satisfaction
- MeSH terms
- Female, Finland, Heart Failure, Humans, Male, Middle Aged, Monitoring, Physiologic, Patient Compliance, Self Care, Telenursing, Home Health Nursing
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