Clinical and psychological telemonitoring and telecare of high risk heart failure patients.

We conducted a trial of telemonitoring and telecare for patients with chronic heart failure leaving hospital after being treated for clinical instability. Eighty patients were randomized before hospital discharge to a usual care group (n=40: follow-up at the outpatient clinic) or to an integrated management group (n=40: patients learned to use a handheld PDA and kept in touch daily with the monitoring centre). At enrolment, the groups were similar for all clinical variables. At one-year follow-up, integrated management patients showed better adherence, reduced anxiety and depression, and lower NYHA class and plasma levels of BNP with respect to the usual care patients (e.g. NYHA class 2.1 vs 2.4, P<0.02). Mortality and hospital re-admissions for congestive heart failure were also reduced in integrated management patients (P<0.05). Integrated management was more expensive than usual care, although the cost of adverse events was 42% lower. In heart failure patients at high risk of relapse, the regular acquisition of simple clinical information and the possibility for the patient to contact the clinical staff improved drug titration, produced better psychological status and quality of life, and reduced hospitalizations for heart failure.

Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study.

Given that many patients referred to cardiac rehabilitation (CR) are obese, diet therapy, exercise training, nutritional and psychological counselling for both obesity and psychological distress should be included as important components in all CR programmes. In this practice-level, observational study we evaluated the short-term within-group effects of a four-week multi-factorial inpatient CR programme specifically addressed to weight loss, fitness improvement and psychological health increase on 176 obese in-patients with coronary heart disease (CHD). Outcome measures were exercise capacity measured with estimated metabolic equivalents (METs), body mass index (BMI) and psychological well-being (PGWBI). Results show statistically significant improvements in all the PGWBI sub-scales and total score, except in general health (p = 0.393). No moderation effects were found for BMI class, age, diabetes and ejection fraction (EF). METs significantly increased by 30.3% (p < 0.001) and BMI decreased by 1.37 points (p < 0.001). Significant correlations were found between BMI and weight reductions with PGWBI anxiety and total score improvements. This multi-disciplinary CR programme including diet therapy, exercise training and psychological counselling provides indication for short-term within-group effectiveness on functional exercise capacity, BMI and PGWBI in a sample of obese in-patients with CHD. However, controlled studies are needed to corroborate the results we found.