Author + information
- Sebastian Winkler, MD* ( and )
- Friedrich Koehler, MD
- ↵*Charité Universitätsmedizin Berlin, Department of Cardiology, Campus Mitte, Chariteplatz 1, D-10117 Berlin, Germany
Structured disease management improves the prognosis of patients with chronic heart failure and has already been included in the current treatment guidelines. Along with better medication and increased use of defibrillators, planned periodic visits have also become routine in clinical practice. Remote patient monitoring (RPM) is a different type of structured disease management. Although the RPM systems (telephone support, network care, device-assisted monitoring) and health care environments are heterogeneous, the crucial difference from usual care is that RPM enables daily contact with healthcare experts and thus facilitates regular short-term evaluation of the disease status and early intervention. The elaborate meta-analysis by Klersy et al. (1) pointed out considerable benefits to be gained from RPM in terms of mortality and hospital stay. This result is misleading. Should we now offer RPM to the millions of heart failure outpatients? The most recent trials (2,3) failed to demonstrate convincing benefits in these end points. What caused the discrepancy? In the era of good baseline medication, growing defibrillator implantation rates, scheduled visits, and good self care, it is essential to identify the patients who might benefit from additional RPM and also those who will not. What are the determinants of outpatient responsiveness? When should RPM be used and for how long? What systems are most suitable? What makes interventions effective? Apart from the diversity of healthcare delivery systems requiring coordination in each country, there might be disease-related determinants of receptivity to RPM. The efforts of future trials should focus on these aspects. The challenge is to identify patients who require daily contact with healthcare experts as well as those who can continue to receive usual care without harm. A very smart technology calls for very intelligent clinical implementation.
- American College of Cardiology Foundation