Efficacy of a Telemonitoring System as a Complementary Strategy in the Treatment of Patients With Heart Failure: Randomized Clinical Trial.

Episodes of decompensation are the main cause of hospital admissions in patients with heart failure. For this reason, the use of mobile apps emerges as an excellent strategy to improve coverage, real-time monitoring, and timeliness of care. ControlVit is an electronic application for early detection of complications studied within the context of a tertiary university hospital. Patients were randomized to the use of ControlVit versus placebo, during a 6-month follow-up. The primary outcome was the difference in numbers of readmissions and deaths for heart failure between both groups. One hundred forty patients were included (intervention = 71, placebo = 69), with an average age of 66 years old; 71% were men. The main etiology of heart failure was ischemic (60%), whereas the main comorbidities were arterial hypertension (44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus (27%). The primary outcome occurred more frequently in the control group: readmission due to decompensation for heart failure (control group n = 14 vs intervention group n = 3; P = .0081), and death (control group n = 11 vs intervention group n = 3; P = .024). In heart failure patients, ControlVit is a useful and supplementary tool, which reduces hospital admissions due to episodes of decompensation.

Evaluation of a Mobile Application for Heart Failure Telemonitoring.

Adequate adherence to treatment is indispensable in preventing adverse consequences in heart failure patients. Such adherence can be managed through heart failure clinics and various methods of follow-up. In recent years, the use of telemonitoring has shown promising benefits in supporting clinicians' follow-up, as well as contributing to patients' self-care. This article presents the development and evaluation of a telemonitoring application for heart failure, through a Web-based interface for clinicians and a mobile application for patients. The application was evaluated through a 6-month pilot observational descriptive study in 20 outpatients with reduced ejection fraction and two nurses, in the context of a heart failure clinic. A technological acceptance questionnaire was applied to all patients and nurses at the end of the study period. In use, the application generated 64 real-time alerts for early decision-making to prevent complications, and 91% of patients did not present hospital readmissions. Such results, along with high user acceptance, show potential utility of the application as an effective complementary strategy for follow-up of patients with heart failure.

Evaluation of Long-Term Kidney Function Following Orthotopic Heart Transplantation.

INTRODUCTION: Acute impairment of kidney function in patients with heart failure and heart transplantation is a frequent condition. However, the impact of the transplant on long-term kidney function remains controversial. METHODS: This study describes a cohort of patients who received a heart transplant in a reference hospital between 2005 and 2019. Glomerular filtration rate during follow-up was calculated at 0, 6,12, 24, and 60 months using the Cockcroft-Gault and MDRD (modification of diet in renal disease study) equations. To identify changes we compared glomerular filtration rate (GFR) at baseline with measurements over time after heart transplantation, using a paired t test and a longitudinal model of Generalized Estimating Equations (GEE). RESULTS: Forty-four patients were included. The mean of baseline GFR was 67.9 ± 1.3 mL/min. A triple immunosuppressive therapy scheme was used with cyclosporine/tacrolimus, mycophenolate mofetil, and steroid, with progressive dose reduction. After adjusting for multiple variables, we found no reduction of GFR over time with the GEE model. There was no significant difference in GFR using Cockcroft-Gault equation at 6 (mean difference [MD] 4.46; confidence interval [CI] -2.1 to 11.09; P = 0.18), 12 (MD 1.65, CI -4.5 to 7.82; P = 0.59), 36 (MD 0.69; CI -6.04 to 7.43; P = 0.83), and 60 months (MD 0.62; CI -5.5 to 6.79; P = 0.83). Similar findings were found using MDRD equation. CONCLUSIONS: There is no significant GFR decline between the time of heart transplantation and a follow-up at 60 months. New studies are needed to evaluate changes in renal function beyond this timeframe.

Intermediate Monocytes and Cytokine Production Associated With Severe Forms of Chagas Disease.

Monocytes are classified according to their CD14 and CD16 expression into classical (reparative), intermediate (inflammatory), and non-classical. This study assessed the frequency of monocyte and the relationship between monocyte subset percentages and the levels of blood cytokines in Colombian chagasic patients with different clinical forms. This study included chagasic patients in different clinical stages: indeterminate (IND) n = 14, chronic chagasic cardiomyopathy (CCC) n = 14, and heart transplant chagasic (HTCC) n = 9; controls with non-chagasic cardiopathy (NCC) n = 15, and healthy individuals (HI) n = 15. Peripheral blood mononuclear cells (PBMCs) were isolated, labeled for CD14, CD16, and HLA-DR, and analyzed by flow cytometry. Cytokines were measured with a bead-based immunoassay. Percentages of total CD14+ CD16+ and CD14+ HLA-DR+ monocytes were higher in patients with heart involvement (CCC, HTCC, and NCC) than controls. Percentages of intermediate monocytes increased in symptomatic chagasic patients (CCC and HTCC) compared to asymptomatic chagasic patients (IND) and controls (HI). Asymptomatic chagasic patients (IND) had higher percentages of classical monocytes, an increased production of CCL17 chemokine compared to chagasic symptomatic patients (CCC), and their levels of CCL17 was positively correlated with the percentage of classical monocyte subset. In CCC, the percentages of intermediate and classical monocytes were positively correlated with IL-6 levels, which were higher in this group compared to HI, and negatively with IL-12p40 concentration, respectively. Remarkably, there also was an important increased of classical monocytes frequency in three chronic chagasic patients who underwent cardiac transplant, of which one received anti-parasitic treatment. Our findings suggest that cardiac chagasic patients have an increased percentage of inflammatory monocytes and produce more IL-6, a biomarker of heart failure and left ventricular dysfunction, whereas asymptomatic chagasic individuals present a higher percentage of reparative monocytes and CCL17.

Modelo de aceptación tecnológica de la aplicación móvil de seguimiento ControlVit® en pacientes con falla cardiaca / Technological acceptance model of the ControlVit® mobile monitoring application in patients with heart failure

Resumen Introducción: Los sistemas de monitoreo remoto basados en teléfonos inteligentes para pacientes con falla cardiaca podrían ser herramientas sencillas y económicas para mejorar el seguimiento ambulatorio. Objetivo: Identificar la utilidad y aceptación de la aplicación ControlVit® en pacientes con falla cardiaca. Método: Estudio piloto observacional descriptivo, en 20 pacientes ambulatorios con fracción de eyección reducida, que asisten a un programa de falla cardiaca. Durante seis meses, los pacientes utilizaron la aplicación ControlVit®, que suministra al paciente información para mejorar su autocuidado y permite el registro diario de variables médicas relevantes. Los datos se consignaron en la bitácora del sistema para verificar la frecuencia y el envío de datos. Se aplicó un cuestionario de aceptación tecnológica (TAM) a todos los pacientes y profesionales. Resultados: 100% de los pacientes reconoció la utilidad de la aplicación frente a su autocuidado, 90% niegan ansiedad tecnológica o temor para emplearla por la facilidad de uso. En general, se detectaron 164 alertas en tiempo real ―el aumento de peso fue la más frecuente (49%)―, y en 91% de los pacientes no se registraron reingresos hospitalarios. Conclusión: la aplicación ControlVit® es útil para la detección temprana de síntomas que permiten identificar, de forma precoz, complicaciones y modificar su tratamiento. La excelente aceptación de la aplicación por parte de los pacientes y su facilidad de uso plantean la posibilidad de implementarla como una estrategia complementaria de seguimiento en pacientes con falla cardiaca.

Abstract Introduction: Mobile phone based remote monitoring systems for heart failure patients could become simple and affordable tools to improve home management. Objective: to identify utility and acceptance of ControlVit® in heart failure patients. Method: descriptive observational pilot study in 20 outpatients with reduced ejection fraction, attending at hospital heart failure program. For six months, patients use the ControlVit® application, which supplies patient information to improve self-care and allows daily recording of specific medical variables. The data was recorded in the system log to verify frequency and data transmission. A technological acceptance questionnaire (TAM) was applied to all patients and professionals. A descriptive analysis with absolute and relative frequency distribution was also performed. Results: 100% of patients recognized the usefulness of the application compared to self-care, 90 % deny technological anxiety or fear of using it due to the ease of use. Overall, 164 real-time alerts were detected, weight gain was the most frequent (49 %) and 91 % of patients had no hospital readmissions. Conclusion: The ControlVit® application is useful for the early detection of symptoms that allow timely detection of complications and early modification of treatment. The excellent acceptance of the application by patients and its ease of use, raise the possibility of implementing it as a complementary monitoring strategy in patients with heart failure.

Factores de riesgo asociados a estancia hospitalaria prolongada en pacientes con falla cardiaca aguda / Risk factors associated with prolonged hospital stay in patients with acute heart failure

Resumen Introducción:: La falla cardiaca aguda es un motivo frecuente de consulta a urgencias, genera estancias hospitalarias prolongadas y altos costos para el sistema de salud. Objetivo: Determinar los factores asociados a estancia hospitalaria prolongada en pacientes hospitalizados por falla cardiaca aguda en un hospital universitario. Métodos: Estudio de cohorte retrospectivo, se incluyeron pacientes adultos con falla cardiaca aguda. Se obtuvieron variables demográficas, comorbilidades y resultados de laboratorios de rutina. Se definió hospitalización prolongada, como una estancia mayor a 5 y 10 días respectivamente. Resultados: Un total de 776 pacientes fueron incluidos en el análisis, 56% eran hombres, el promedio de edad fue de 71.5 años, fracción de eyección de 39.8%. Los factores asociados con estancia hospitalaria prolongada fueron: edad, elevación de troponina, hiperglucemia y albúmina < 3 g/dl. Para el corte de 10 días adicionalmente se identificaron: presión arterial sistólica, frecuencia cardiaca y elevación de péptidos natriuréticos. Conclusiones: La evaluación integral de variables clínicas y resultados de laboratorio es útil para identificar pacientes con mayor riesgo de estancias hospitalarias prolongadas.

Abstract Introduction: Acute heart failure is a frequent reason for consulting to emergency department, it generates long hospital stays and high costs for the health system. Objective: To determine the associated factors with prolonged hospital stay in patients hospitalized for acute heart failure in a teaching hospital. Methods: Retrospective cohort study, adult patients with acute heart failure were included. Demographic variables, comorbidities, and routine laboratory results were obtained. Prolonged hospitalization was defined as a stay greater than 5 and 10 days, respectively. Results: A total of 776 patients were included in the analysis, 56% were men, the mean age was 71.5 years, and ejection fraction was 39.8%. Factors associated with prolonged hospital stay were: age, elevated troponin, hyperglycemia, and albumin < 3 g/dl. For the 10-day cut-off, additionally, systolic blood pressure, heart rate and elevation of natriuretic peptides were identified. Conclusions: Comprehensive evaluation of clinical variables and laboratory results is useful to identify patients at increased risk for prolonged hospital stays.