Abstract
Introduction Congestive heart failure (CHF), which typically affects older people, is characterized by high short- and mid-term mortality rates. However, despite accumulating evidence showing that administration of β-blockers (β-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these agents in adequate dosages in this setting is not routine. One reason for this appears to be a concern about a possible risk of bradyarrhythmia associated with use of β-blockers. Telecardiology has recently been investigated as a means of constantly monitoring the heart rate of CHF patients in their homes. Its use may allay concerns about the risk of bradyarrhythmia and facilitate a more widespread use of β-blockers in this context.
Objectives The primary objectives of this study were to assess the impact of telemonitoring on patients’ adherence to prescribed therapeutic regimens, particularly β-blockers, and to explore whether use of home telemonitoring reduces mortality and rate of re-admission to hospital in elderly CHF patients compared with normal specialized CHF team care.
Methods A total of 57 patients with CHF (31 New York Heart Association [NYHA] class II, 23 NYHA class III and 3 NYHA class IV), with a mean ±SD age of 78.2±7.3 years, were randomized to a control group who received standard care, based on routinely scheduled clinic visits, from a team specialized in CHF patient management, or to a home telemonitoring group (TM group), managed by the same specialized CHF team. Patients were followed up over 12 months.
Results Compared with the control group, the TM group had a significant increase in the use of β-blockers, HMG-CoA reductase inhibitors (statins) and aldosterone receptor antagonists. A reduction in nitrate administration compared with baseline was also seen in the TM group. The 12-month occurrence of the primary combined endpoint of mortality and hospital re-admission for CHF was significantly lower in the TM group than in the control group (p < 0.01).
Conclusions This study showed that a home-care model including telemonitoring of relevant clinical parameters may provide useful support in the management of patients with CHF. Home telemonitoring in CHF patients was associated with increased use of β-blockers at appropriate doses, suggesting that this strategy reassured physicians regarding the safety of careful use of these agents in this setting. However, larger studies are required to confirm these findings. Our findings indicate that there is a need to investigate relevant parameters in CHF patients at the point of care (i.e. in patients’ daily lives), which can in turn optimize β-blocker and other drug therapy.
References
McCullough PA, Philbin EF, Spertus JA, et al. Confirmation of a heart failure epidemic: findings from the Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 2002; 39: 60–9
Garg RG, Yusuf S. Overview of randomised trials of angiotensin-converting enzyme inhibitors on mortality and morbilityin patients with heart failure. JAMA 1995; 273: 1540–6
Swedberg K, Hjalmason A, Waagstein F, et al. Prolongation of survival in congestive cardiomyopathy by beta-blockade. Lancet 1979; I: 1374–6
Swedberg K, Hjalmarson A, Waagstein F, et al. Beneficial effects of long term beta-blockade in congestive cardiomyopathy. Br Heart J 1980; 44: 117–33
Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomized Intervention in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7
The Cardiac Insufficiency Bisoprolol Study II (CIBIS II): a randomised trial. Lancet 1999; 353: 9–13
Colucci WS, Paker M, Bristow MR, et al., US Carvedilol Heart Failure Study Group. Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. Circulation 1996; 94: 2800–6
Parker M, Colucci WS, Sackner-Bernstein JD, et al., PRECISE Study Group. Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure: the Prospective Randomized Evalutation of Carvedilol in Symptoms and Exercise (PRECISE) trial. Circulation 1996; 94: 2793–9
Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344: 1651–8
Yancy CW, Fowler MB, Colucci WS, et al. Race and response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med 2001; 344: 1358–65
Krum H, Haas SJ, Eichhorn E, et al. Prognostic benefit of beta-blockers in patients not receiving ACE-inhibitors. Eur Heart J 2005; 26: 2154–8
Chan JD, Rea TD, Smith NL, et al. Association of beta-blocker use with mortality among patients with congestive heart failure in the Cardiovascular Health Study (CHS). Am Heart J 2005; 150: 464–70
López-Sendón J, Swedberg K, McMurray J, et al. Task Force on Beta-Blockers of the European Society of Cardiology Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J 2004 Aug; 25(15): 1341–62
Dargie HJ. Effect of carvedilol on outcome after myocardial infarction patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001; 357: 1385–90
Maggioni AP, Sinagra G, Opasich C, et al., Beta Blockers in Patients with Congestive Heart Failure: Guided Use in Clinical Practice Investigators. Treatment of chronic heart failure with beta adrenergic blockade beyond controlled clinical trials: the BRING-UP experience. Heart 2003 Mar; 89(3): 299–305
Opasich C, Boccanelli A, Cafiero M, et al., BRING-UP 2 Investigators. Programme to improve the use of beta-blockers for heart failure in the elderly and in those with severe symptoms: results of the BRING-UP 2 study. Eur J Heart Fail 2006 Oct; 8(6): 649–57
Krum H, Hill J, Fruhwald F, et al. Tolerability of beta-blockers in elderly patients with chronic heart failure: the COLA II study. Eur J Heart Fail 2006 May; 8(3): 302–7
Spaeder J, Najjar SS, Gerstenblith G, et al. Rapid titration of carvedilol in patients with congestive heart failure: a randomized trial of automated telemedicine versus frequent outpatient clinic visits. Am Heart J 2006 Apr; 151(4): 844.e1-10
Moyer-Knox D, Mueller TM, Vuckovic K, et al. Remote titration of carvedilol for heart failure patients by advanced practice nurses. J Card Fail 2004 Jun; 10(3): 219–24
Antonicelli R, Testarmata P, Spazzafumo L, et al. Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. J Telemed Telecare 2008; 14: 300–5
Acknowledgements
No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Antonicelli, R., Mazzanti, I., Abbatecola, A.M. et al. Impact of Home Patient Telemonitoring on Use of β-Blockers in Congestive Heart Failure. Drugs Aging 27, 801–805 (2010). https://doi.org/10.2165/11538210-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11538210-000000000-00000