JACC: Benefits of home monitoring for HF yet to be fully seen
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Gregg C. Fonarow, MD, from the Ahmanson-University of California, Los Angeles (UCLA) Cardiomyopathy Center and colleague Anh L. Bui discussed the challenges in monitoring patients with HF, and highlighted ongoing investigations into the optimal approaches to home monitoring for HF.
“With a prevalence of 5.8 million in the U.S. alone, HF is a common syndrome associated with substantial morbidity, mortality, and healthcare expenditures,” the authors wrote. “Close to one million HF hospitalizations occur annually in the U.S., with the majority of these resulting from worsening congestion in patients previously diagnosed with HF. An estimated $37.2 billion is spent each year on HF in the U.S. These statistics emphasize the need to develop and implement more effective strategies to assess, monitor, and treat HF.”
According to the authors, the difficulty in managing HF is not only evident by a high rate of HF hospitalizations, currently estimated at approximately one million annually in the U.S., but also by a 30-day readmission rate of 27 percent.
“Home monitoring of the patient with HF can extend from home visitations and promotion of self-care to telemedicine and remote monitoring of external or implantable devices,” the authors wrote. “The advancement of technology has allowed for the development of more advanced home-monitoring techniques, including implanted hemodynamic sensors, which are particularly promising. In patients with New York Heart Association (NYHA) functional class III HF, a wireless implanted hemodynamic monitoring system has now been demonstrated to improve health status and reduce HF hospitalizations.”
Yet challenges lie ahead. Further studies to identify which patient population will derive the greatest benefit from home monitoring are needed. Identifying which variables are best to monitor also requires further study, whether it be patient symptoms, directly recorded data such as heart rate, blood pressure, or pulmonary artery pressures or calculated measurements such as intrathoracic impedance. However, monitoring patient behaviors such as medication adherence maybe more important.
Most likely, any successful approach will need to be multipronged, Fonarow and Bui wrote. Monitoring alone, without adequate follow-up and feedback to the patient, is unlikely to be an answer that prevents HF readmissions or decompensation.
“Whether home-monitoring approaches for HF will live up to their full potential of improving quality of life, functional status and HF outcomes while reducing healthcare expenditures in the broad population of patients with HF remains to be seen,” the authors concluded.