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Phone telemonitoring after heart-failure flare

Home mobile-phone telemonitoring after acute heart-failure decompensation cut primary events and hospital days versus usual care.

Source

Effect of home-based telemonitoring using mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation: randomized controlled trial

Scherr D, Kastner P, Kollmann A, et al. · Journal of medical Internet research · 2009

doi.org/10.2196/jmir.1252Read the full paper ↗185 citationscc by

What they did

MOBITEL randomized 120 patients after acute decompensation to home telemonitoring via mobile phones versus control across eight centres, following primary death/HF hospitalization endpoints for 6 months.

What they found

ITT primary events 17% tele vs 33% control (RRR 50%, P=.06); per-protocol RRR 54% (P=.04); NYHA improved only in tele group; HF hospital stays shorter (median 6.5 vs 10 days).

The limits

What it doesn't show

Whether modern smartphones change effect sizes, and some patients were “never beginners” unable to use equipment.

Key terms

Telemonitoring
Remote transmission of patient physiologic/symptom data for clinical oversight.
Acute decompensation
Worsening heart failure prompting acute care before enrolment.
NYHA class
Functional class of heart-failure symptom limitation.
Intention-to-treat (ITT)
Analyze as randomized, including non-starters.
Per-protocol analysis
Analyze participants who followed assigned monitoring as intended.
Relative risk reduction
Proportional decrease in event risk in intervention vs control.

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ITT primary events were roughly:

Common questions

What was the ITT primary-event contrast?

17% tele vs 33% control (RRR 50%, P=.06).

Did per-protocol results strengthen?

Yes—15% events in tele group, RRR 54%, P=.04.

Did symptoms improve?

Median NYHA improved 3→2 only in the tele group.

Hospital length of stay?

Shorter in tele patients hospitalized for worsening HF (6.5 vs 10 days).

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