Effects of tailored telemonitoring on functional status and health-related quality of life in patients with heart failure.

BACKGROUND: Functional status and health-related quality of life (HRQoL) are important in patients with heart failure (HF). Little is known about the effect of telemonitoring on functional status and HRQoL in that population. METHODS AND RESULTS: A total of 382 patients with HF (New York Heart Association class 2-4) were included in a randomised controlled trial to investigate the effect of tailored telemonitoring on improving HRQoL and functional status in HF patients. Randomisation was computer-generated with stratification per centre. At baseline and after 12 months, patients' functional status was determined by metabolic equivalent scores (METS). HRQoL was measured with the EuroQol five dimensions questionnaire (EQ-5D), visual analogue scale (VAS) and Borg rating of perceived exertion scale (Borg). Additional outcome data included number of HF-related outpatient clinic visits and mortality. Telemonitoring was statistically significantly related to an increase in METS after 1 year (regression coefficient 0.318; p = 0.01). Telemonitoring did not improve Borg, EQ-5D or VAS scores after 1 year. EQ-5D [hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.07-0.54], VAS (HR 0.98, 95% CI 0.96-0.99), Borg (HR 1.21, 95% CI 1.11-1.31) and METS (HR 0.73, 95% CI 0.58-0.93) at baseline were significantly associated with survival after 12 months. CONCLUSIONS: Tailored telemonitoring stabilised the functional status of HF patients but did not improve HRQoL. Therefore, telemonitoring may help to prevent deterioration of exercise capacity in patients with HF. However, because our study is a reanalysis of a randomised controlled trial (RCT), this is considered hypothesis-generating and should be confirmed by adequately powered RCTs.

Electrophysiologic mechanisms and electrocardiographic findings in atrioventricular-nodal reentrant tachycardia in a patient with the scimitar syndrome.

We describe a case of a 68-year-old man with scimitar syndrome and an atrioventricular-nodal reentrant tachycardia treated with adenosine. The emphasis in this article is on the electrophysiologic mechanism of and electrocardiographic (ECG) findings in this case of atrioventricular-nodal reentrant tachycardia.

Torsion of the gallbladder.

Two patients are presented with torsion of the gallbladder, a rare disorder mainly seen in elderly women. The postoperative course was uneventful in both patients. The anatomic abnormalities which allow torsion of the gallbladder are discussed together with some etiological factors. The prognosis of this disorder is favorable when cholecystectomy is performed without delay.