Author + information
- Friedrich Koehler, MD⁎ ( and )
- Stefan D. Anker, MD, PhD
- ↵⁎Charité-Universitätsmedizin Berlin, Department of Cardiology, Campus Mitte, Charitéplatz 1, D-10117 Berlin, Germany
Cleland et al. (1) for the first time demonstrated that telemedical support in the follow-up of ambulatory patients with chronic heart failure (CHF) compared to usual care is associated with survival benefits as well as reduced length of hospitalization. The greatest financial burden of CHF for society is associated with its high hospitalization rates. Cleland et al. showed that hospitalization rates were reduced in the group of patients receiving telemedical care, but not in patients receiving nurse-led care. Their study sets a new standard in telemedical research. The introduction of future technology will not be possible without investigating the effects on morbidity and mortality.
During the last five years, three generations of telemedical systems have been introduced. The first-generation system was based on sensors typically employing conventional telephone systems to transfer data into central databases, which was then—without analysis—transferred to physicians. The second-generation system involved the use of additional sensors, but the main difference was in the additional processing of the incoming data. The system employed in the study by Cleland et al. (1) represents this approach. The main structural problems of these systems are the divided responsibility in all decision-making processes and that direct patient contact is not utilized. Hence, their medical impact is indirect and delayed.
Nevertheless, this system is faster than a nurse-based system, which might be the reason for its better effectiveness. It would have been interesting to see data on the average time span between problem detection and relay of information to the treating physician and between the time when information was received and execution of changes in patient care. A reduction of this time span—as in acute coronary care—could be the key to further reduce mortality rates, particularly with regards to sudden death. Additional information on the cause of death would have been important. We hypothesize that in the present study, nurse-led care as well as telemedicine, compared to usual care, reduced the occurrence of death due to progressive deterioration of cardiac failure, but not the rate of sudden death. When developing future telemedical systems, we need to carefuly evaluate the different parameters for their contribution in making meaningful therapeutic decisions. Do the researchers have data on which information was required in making management decisions?
The medical impact of third-generation telemedical systems will be direct and immediate. Decisions will be based on incoming data, the patient’s history, current treatment, and direct patient contact. Such systems are in development (2). The introduction of these systems will allow development of telemedical systems into tele-home-care networks that assist physicians and nurses in the ambulatory treatment of CHF patients. Havranek (3), suggested that telemedical approaches will be successful when the involved parties know each other. We agree, and we believe that only a third-generation telemedical system will be able to achieve this.
- American College of Cardiology Foundation
- Cleland J.G.,
- Louis A.A.,
- Rigby A.S.,
- Janssens U.,
- Balk A.H.
- ↵Next Generation Media. Available at: www.nextgenerationmedia.de. Accessed June 2, 2006.
- Havranek E.P.