- Study delivers arguments in favor of telemedicine in the case of patients with heart failure
- System proves its worth as valuable support for physicians
- Greater security for patients as a result of improved care in the home
Düsseldorf – Telemedical monitoring can significantly improve the quality of life and life expectancy of cardiac risk patients. This is the finding of a randomized controlled study presented this week by Partnership for the Heart (PfH), a medical-technological consortium, at a congress of the American Heart Association.
The study of telemedical interventional monitoring in heart failure (TIM-HF), conducted as part of the PfH project, furnished evidence that the quality of life of patients under telemedical care improves significantly. Moreover, it was possible to reduce mortality among high-risk patients. Conducted in Germany, the study is exceptionally precise and comprehensive in design. No other study has been conducted for so long with so many patients. “This underscores the significance of its findings,” said the chairman of the TIM-HF steering committee, Prof. Dr. Stefan Anker of Charité Universitätsmedizin Berlin. The TIM-HF study was carried out under the joint auspices of the Charité Hospital in Berlin and the Robert Bosch Hospital in Stuttgart. The medical personnel taking part received technological support from Bosch, a supplier of technology and services, from Aipermon GmbH & Co. KG, and from InterComponentWare AG (ICW). The German Ministry for Science and Technology (BMWi) has given the project a roughly seven million euro grant.
In the study, a population of 710 patients with chronic heart failure were followed up over a more than two-year period. The participants were divided into two equal groups on a random basis. The control group was treated according to current medical principles, while the intervention group received additional telemedical care on a daily basis.
Mortality halved
Among the non-depressive patients with sufficient cardiac output who were treated in hospital for decompensation in the two previous years, mortality as a result of cardiovascular conditions was half as high in the intervention group as in the control group. TIM-HF thus precisely defines for the first time which patients with chronic heart failure will benefit most from telemedical care.
Among the patients, acceptance of telemedical care was high. “The patients quickly realized that telemedicine offers them a significant improvement in quality of life,” said Dr. Ulrich Behner, managing director of Bosch Healthcare. As the lead company of the technical consortium, Bosch healthcare was responsible for system integration, ongoing operation, and the quality of the overall system. Apart from the enhanced feeling of security, Behner said, there was the benefit that patients were able to stay at home, in their familiar social environment. This form of care was also well received by patients in rural areas, who otherwise had to travel long distances to their attending physician. Regular, standardized patient surveys provided statistical evidence of improved quality of life.
System proves its practical value
In the study, a telemonitoring system was used that remotely monitors patients by measuring and transmitting vital parameters. Apart from measuring blood pressure and body weight, patients performed an ECG themselves on a daily basis. In addition, each patient provided a self-assessment, which provided important information about their subjective state of health. “Surprisingly, we found that the patients’ appraisals were usually a good interpretation of their objective values,” said Dr. Michael Schieber, deputy clinical director and senior physician at the Robert Bosch Hospital. For the first time, the study also included a monthly exercise (walk) test, the results of which were measured using a new activity sensor developed by Aipermon. In the case of acute heart complaints, for example, a social alarm system means that a push of a button is all that is needed to establish an audio connection to the telemedical monitoring center. An ECG under oxygen saturation conditions is then performed and transmitted in real time to the telemedical monitoring center The physician at the center can use this information as the basis for further necessary measures. “The use of mobile telemedical measuring systems allows patients to be treated better in the home. Care has been taken to ensure that the systems are easy to operate for patients, and that their medical data can be transmitted quickly, securely, and reliably,” said Dr. Thomas Schweizer of Aipermon.
All measured values, as well as case history notes, were saved in an electronic case book which could be accessed by the telemedical monitoring centers of the Charité and the Robert Bosch Hospital. In addition, the structure of the software used at the telemedical monitoring workstation was based on the telemedical processes, so that simple workflows were ensured. “The high level of integration of the system components and the high level of automation in the system as a whole also made the system easy to operate for the staff in the telemedical monitoring centers. To achieve this, the various users were closely involved in the development phase, and so optimum processes were ensured,” said Dr. Peter Heinze of ICW.
Supporting physicians
“The telemedical monitoring centers help physicians in private practice care for chronically ill patients, but they cannot replace physicians,” said Dr. Friedrich Köhler, the principal investigator, consortium manager, senior physician, and director of the Center for Cardiovascular Telemedicine at the Charité Hospital. The study demonstrated the benefits of the cross-sectoral collaboration of telemedical monitoring centers and physicians and specialists in private practice. Changes in state of health were identified more quickly, and remedial action could be taken rapidly with the close involvement of all parties. In some cases, the intensive care resulting from the collaboration of physicians in private practice and the telemedical monitoring centers saved lives.
Significance of the study
Because of its especially comprehensive approach and pioneering character, the study had been eagerly awaited by health professionals. At the American Heart Association congress held this week in Chicago, the study’s findings caused a sensation among heart specialists. The methods used have met with broad acceptance. Indeed, a number of experts regard the approach as exemplary for new studies. The detailed findings of the TIM-HF study will also be published in a leading medical journal. “The study unequivocally demonstrates the benefits of telemedicine for clearly defined patient groups,” Köhler said. It is now up to healthcare providers and politicians to take the decisions that will allow many people in Germany to benefit from this solution quickly. Following these initial findings, the results of the accompanying study into the costs of this form of healthcare will be presented next year. Further detailed analyses will also be carried out.
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Andreas Kempf,
Bosch press spokesperson
Tel. +49 (711) 811-6285
Andreas.Kempf@de.bosch.com
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