Patterns in the Use of Heart Failure Telemonitoring: Post Hoc Analysis of the e-Vita Heart Failure Trial

BACKGROUND: Research on the use of home telemonitoring data and adherence to it can provide new insights into telemonitoring for the daily management of patients with heart failure (HF). OBJECTIVE: We described the use of a telemonitoring platform-including remote patient monitoring of blood pressure, pulse, and weight-and the use of the electronic personal health record. Patient characteristics were assessed in both adherent and nonadherent patients to weight transmissions. METHODS: We used the data of the e-Vita HF study, a 3-arm parallel randomized trial performed in stable patients with HF managed in outpatient clinics in the Netherlands. In this study, data were analyzed from the participants in the intervention arm (ie, e-Vita HF platform). Adherence to weight transmissions was defined as transmitting weight ≥3 times per week for at least 42 weeks during a year. RESULTS: Data from 150 patients (mean age 67, SD 11 years; n=37, 25% female; n=123, 82% self-assessed New York Heart Association class I-II) were analyzed. One-year adherence to weight transmissions was 74% (n=111). Patients adherent to weight transmissions were less often hospitalized for HF in the 6 months before enrollment in the study compared to those who were nonadherent (n=9, 8% vs n=9, 23%; P=.02). The percentage of patients visiting the personal health record dropped steadily over time (n=140, 93% vs n=59, 39% at one year). With univariable analyses, there was no significant correlation between patient characteristics and adherence to weight transmissions. CONCLUSIONS: Adherence to remote patient monitoring was high among stable patients with HF and best for weighing; however, adherence decreased over time. Clinical and demographic variables seem not related to adherence to transmitting weight. TRIAL REGISTRATION: ClinicalTrials.gov NCT01755988; https://clinicaltrials.gov/ct2/show/NCT01755988

Developing a personalized remote patient monitoring algorithm: a proof-of-concept in heart failure

Aims Non-invasive remote patient monitoring is an increasingly popular technique to aid clinicians in the early detection of worsening heart failure (HF) alongside regular follow-ups. However, previous studies have shown mixed results in the performance of such systems. Therefore, we developed and evaluated a personalized monitoring algorithm aimed at increasing positive-predictive-value (PPV) (i.e. alarm quality) and compared performance with simple rule-of-thumb and moving average convergence-divergence algorithms (MACD). Methods and results In this proof-of-concept study, the developed algorithm was applied to retrospective data of daily bodyweight, heart rate, and systolic blood pressure of 74 HF-patients with a median observation period of 327 days (IQR: 183 days), during which 31 patients experienced 64 clinical worsening HF episodes. The algorithm combined information on both the monitored patients and a group of stable HF patients, and is increasingly personalized over time, using linear mixed-effect modelling and statistical process control charts. Optimized on alarm quality, heart rate showed the highest PPV (Personalized: 92%, MACD: 2%, Rule-of-thumb: 7%) with an F1 score of (Personalized: 28%, MACD: 6%, Rule-of-thumb: 8%). Bodyweight demonstrated the lowest PPV (Personalized: 16%, MACD: 0%, Rule-of-thumb: 6%) and F1 score (Personalized: 10%, MACD: 3%, Rule-of-thumb: 7%) overall compared methods. Conclusion The personalized algorithm with flexible patient-tailored thresholds led to higher PPV, and performance was more sensitive compared to common simple monitoring methods (rule-of-thumb and MACD). However, many episodes of worsening HF remained undetected. Heart rate and systolic blood pressure monitoring outperformed bodyweight in predicting worsening HF. The algorithm source code is publicly available for future validation and improvement

Patterns in the Use of Heart Failure Telemonitoring:Post Hoc Analysis of the e-Vita Heart Failure Trial

Background: Research on the use of home telemonitoring data and adherence to it can provide new insights into telemonitoring for the daily management of patients with heart failure (HF). Objective: We described the use of a telemonitoring platform—including remote patient monitoring of blood pressure, pulse, and weight—and the use of the electronic personal health record. Patient characteristics were assessed in both adherent and nonadherent patients to weight transmissions. Methods: We used the data of the e-Vita HF study, a 3-arm parallel randomized trial performed in stable patients with HF managed in outpatient clinics in the Netherlands. In this study, data were analyzed from the participants in the intervention arm (ie, e-Vita HF platform). Adherence to weight transmissions was defined as transmitting weight ≥3 times per week for at least 42 weeks during a year. Results: Data from 150 patients (mean age 67, SD 11 years; n=37, 25% female; n=123, 82% self-assessed New York Heart Association class I-II) were analyzed. One-year adherence to weight transmissions was 74% (n=111). Patients adherent to weight transmissions were less often hospitalized for HF in the 6 months before enrollment in the study compared to those who were nonadherent (n=9, 8% vs n=9, 23%; P=.02). The percentage of patients visiting the personal health record dropped steadily over time (n=140, 93% vs n=59, 39% at one year). With univariable analyses, there was no significant correlation between patient characteristics and adherence to weight transmissions. Conclusions: Adherence to remote patient monitoring was high among stable patients with HF and best for weighing; however, adherence decreased over time. Clinical and demographic variables seem not related to adherence to transmitting weight.</p

An ES-Like Pluripotent State in FGF-Dependent Murine iPS cells

Recent data demonstrates that stem cells can exist in two morphologically, molecularly and functionally distinct pluripotent states; a naïve LIF-dependent pluripotent state which is represented by murine embryonic stem cells (mESCs) and an FGF-dependent primed pluripotent state represented by murine and rat epiblast stem cells (EpiSCs). We find that derivation of induced pluripotent stem cells (iPSCs) under EpiSC culture conditions yields FGF-dependent iPSCs from hereon called FGF-iPSCs) which, unexpectedly, display naïve ES-like/ICM properties. FGF-iPSCs display X-chromosome activation, multi-lineage differentiation, teratoma competence and chimera contribution in vivo. Our findings suggest that in 129 and Bl6 mouse strains, iPSCs can dominantly adopt a naive pluripotent state regardless of culture growth factor conditions

Disease management of chronic heart failure

For the optimal management of heart failure, multidisciplinary teams should apply evidence-based therapy with the patient in the center of care. It includes patient-clinician cooperative monitoring, shared-decision making, telemonitoring and implementation of well-established clinical pathways. In this thesis, we have assessed key elements of telemonitoring of stable chronic heart failure patients and the impact of implementation of a multidisciplinary clinical pathway for patients with heart failure caused by cardiac amyloidosis. With a systematic review, we could show that there is considerable heterogeneity among telemonitoring programs and patient management protocols that are currently used. If well-organized, telemonitoring can safely substitute the number of heart failure nurses’ face-to-face contacts with patients. We could show this indirectly; the change (delta) in circulating natriuretic peptides levels in the first year after initiation of a telemonitoring program aimed at substitution of the intensive usual care was safe while reducing health care utilization of stable heart failure patients. Next, we investigated the use of a telemonitoring platform and identified several important aspects with regard to patient adherence. Patients were most adherent to weight transmissions. However, adherence decreased over the year, while clinical and demographic variables were not related to adherence. Finally, we investigated the impact of the implementation of the ‘Utrecht multidisciplinary clinical pathway for amyloidosis’. After implementation, we observed a positive impact on awareness among referring Dutch cardiologists and improvement in diagnostic delay, resulting in a lower disease severity at diagnosis of patients. In conclusion, our results emphasize that eHealth could be helpful in the management of the growing number of patients with heart failure, and that a structured care pathway is useful in the management of patients with cardiac amyloidosis

Algorithms used in telemonitoring programmes for patients with chronic heart failure : A systematic review

INTRODUCTION: Non-invasive telemonitoring programmes detecting deterioration of heart failure are increasingly used in heart failure care. AIM: The aim of this study was to compare different monitoring algorithms used in non-invasive telemonitoring programmes for patients with chronic heart failure. METHODS: We performed a systematic literature review in MEDLINE (PubMed) and Embase to identify published reports on non-invasive telemonitoring programmes in patients with heart failure aged over 18 years. RESULTS: Out of 99 studies included in the study, 20 (20%) studies described the algorithm used for monitoring worsening heart failure or algorithms used for titration of heart failure medication. Most frequently used biometric measurements were bodyweight (96%), blood pressure (85%) and heart rate (61%). Algorithms to detect worsening heart failure were based on daily changes in bodyweight in 20 (100%) studies and/or blood pressure in 12 (60%) studies. In 12 (60%) studies patients were contacted by telephone in the case of measurements outside thresholds. CONCLUSION: Only one in five studies on telemonitoring in chronic heart failure reported the algorithm that was used to detect worsening heart failure. Standardised description of the telemonitoring algorithm can expedite the identification of key components in telemonitoring algorithms that allow accurate prediction of worsening heart failure

Algorithms used in telemonitoring programmes for patients with chronic heart failure : A systematic review

INTRODUCTION: Non-invasive telemonitoring programmes detecting deterioration of heart failure are increasingly used in heart failure care. AIM: The aim of this study was to compare different monitoring algorithms used in non-invasive telemonitoring programmes for patients with chronic heart failure. METHODS: We performed a systematic literature review in MEDLINE (PubMed) and Embase to identify published reports on non-invasive telemonitoring programmes in patients with heart failure aged over 18 years. RESULTS: Out of 99 studies included in the study, 20 (20%) studies described the algorithm used for monitoring worsening heart failure or algorithms used for titration of heart failure medication. Most frequently used biometric measurements were bodyweight (96%), blood pressure (85%) and heart rate (61%). Algorithms to detect worsening heart failure were based on daily changes in bodyweight in 20 (100%) studies and/or blood pressure in 12 (60%) studies. In 12 (60%) studies patients were contacted by telephone in the case of measurements outside thresholds. CONCLUSION: Only one in five studies on telemonitoring in chronic heart failure reported the algorithm that was used to detect worsening heart failure. Standardised description of the telemonitoring algorithm can expedite the identification of key components in telemonitoring algorithms that allow accurate prediction of worsening heart failure

Components of heart failure management in home care; a literature review

BACKGROUND: Patients with heart failure (HF) need long-term and complex care delivered by healthcare professionals in primary and secondary care. Although guidelines on optimal HF care exist, no specific description of components that are applied for optimal HF care at home exist. The objective of this review was to describe which components of HF (home) care are found in research studies addressing homecare interventions in the HF population. METHODS: The Pubmed, Embase, Cinahl, and Cochrane databases were searched using HF-, homecare services-, and clinical trial-related search terms. RESULTS: The literature search identified 703 potentially relevant publications, out of which 70 articles were included. All articles described interventions with two or more of the following components: multidisciplinary team, continuity of care and care plans, optimized treatment according to guidelines, educational and counselling of patients and caregivers, and increased accessibility to care. Most studies (n=65, 93%) tested interventions with three components or more and 20 studies (29%) used interventions including all five components. CONCLUSIONS: There a several studies on HF care at home, testing interventions with a variety in number of components. Comparing the results to current standards, aspects such as collaboration between primary care and hospital care, titration of medication, and patient education can be improved

An unusual cause of atrial tachycardia in a young patient with lymphoma.

Contains fulltext : 80026.pdf (publisher's version ) (Closed access)An 8-year-old girl who was recently diagnosed as having anaplastic large-cell lymphoma presented with atrial tachycardia and dilated cardiomyopathy, which is a contraindication for further treatment with cardio-toxic chemotherapy. After starting digoxin therapy, the dilated cardiomyopathy resolved. Repeated episodes of atrial tachycardia in this case were not caused by any common disorder but were due to mechanical stimulation by a central venous catheter. Central venous catheters are known to cause mainly ventricular arrhythmias. However, atrial tachycardia is a rare manifestation of arrhythmia due to mechanical stimulation of the heart by a central venous catheter, with potentially important cardiovascular consequences