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Feasibility and effectiveness of a multidimensional post-discharge disease management programme for heart failure patients in clinical practice: the HerzMobil Tirol programme.
Poelzl, G; Egelseer-Bruendl, T; Pfeifer, B; Modre-Osprian, R; Welte, S; Fetz, B; Krestan, S; Haselwanter, B; Zaruba, M M; Doerler, J; Rissbacher, C; Ammenwerth, E; Bauer, A.
Afiliação
  • Poelzl G; Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. Gerhard.poelzl@tirol-kliniken.at.
  • Egelseer-Bruendl T; Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
  • Pfeifer B; Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria.
  • Modre-Osprian R; Center for Health and Bioresources, AIT Austrian Institute of Technology, Graz, Austria.
  • Welte S; Center for Health and Bioresources, AIT Austrian Institute of Technology, Graz, Austria.
  • Fetz B; Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria.
  • Krestan S; Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria.
  • Haselwanter B; Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria.
  • Zaruba MM; Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
  • Doerler J; Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
  • Rissbacher C; University Hospital Innsbruck, TirolKliniken, Innsbruck, Austria.
  • Ammenwerth E; Institute of Medical Informatics, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
  • Bauer A; Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Clin Res Cardiol ; 111(3): 294-307, 2022 Mar.
Article em En | MEDLINE | ID: mdl-34269863
ABSTRACT

AIMS:

It remains unclear whether transitional care management outside of a clinical trial setting provides benefits for patients with acute heart failure (AHF) after hospitalization. We evaluated the feasibility and effectiveness of a multidimensional post-discharge disease management programme using a telemedical monitoring system incorporated in a comprehensive network of heart failure nurses, resident physicians, and secondary and tertiary referral centres (HerzMobil Tirol, HMT), METHODS AND

RESULTS:

The non-randomized study included 508 AHF patients that were managed in HMT (n = 251) or contemporaneously in usual care (UC, n = 257) after discharge from hospital from 2016 to 2019. Groups were retrospectively matched for age and sex. The primary endpoint was time to HF readmission and all-cause mortality within 6 months. Multivariable Cox proportional hazard models were used to assess the effectiveness. The primary endpoint occurred in 48 patients (19.1%) in HMT and 89 (34.6%) in UC. Compared with UC, management by HMT was associated with a 46%-reduction in the primary endpoint (adjusted HR 0.54; 95% CI 0.37-0.77; P < 0.001). Subgroup analyses revealed consistent effectiveness. The composite of recurrent HF hospitalization and death within 6 months per 100 patient-years was 64.2 in HMT and 108.2 in UC (adjusted HR 0.41; 95% CI 0.29-0.55; P < 0.001 with death considered as a competing risk). After 1 year, 25 (10%) patients died in HMT compared with 66 (25.7%) in UC (HR 0.38; 95% CI 0.23-0.61, P < 0.001).

CONCLUSIONS:

A multidimensional post-discharge disease management programme, comprising a telemedical monitoring system incorporated in a comprehensive network of specialized heart failure nurses and resident physicians, is feasible and effective in clinical practice.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Telemedicina / Assistência ao Convalescente / Gerenciamento Clínico / Insuficiência Cardíaca Tipo de estudo: Evaluation_studies / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Res Cardiol Assunto da revista: CARDIOLOGIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Áustria

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Telemedicina / Assistência ao Convalescente / Gerenciamento Clínico / Insuficiência Cardíaca Tipo de estudo: Evaluation_studies / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Res Cardiol Assunto da revista: CARDIOLOGIA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Áustria