Evaluation of the AUTONOM@DOM Telemonitoring System for People With Heart Failure

Chronic diseases such as heart failure are a major burden for healthcare systems They are punctuated by exacerbations, often markers of poor prognosis, and are associated with expensive unscheduled hospitalizations. After initial diagnosis, despite the development of both drug and physical therapies, the rate of re-hospitalization for heart failure remains high with 50% or more of patients readmitted within 6 months.

Recommendations for the treatment of heart failure patients are extremely precise and justify close collaboration between local community services and the hospital. However there is often considerable divergence between recommended care and the reality, due in particular to the difficulty in monitoring ambulatory patients. For example, the dose titration of beta-blockers or ACE inhibitors need to be monitored, and dosages of diuretics need to be adapted to avoid side effects which affect the quality of life of patients and limit medication adherence etc. The establishment of 'ambulatory' care networks (including multidisciplinary health professionnals of city and hospital and therapeutic patient education) such as that in Isère County in France has demonstrated its effectiveness.

However, more advanced tools for patient monitoring still need to be assessed, particularly 'home monitoring', because there is not yet consensus as to the role tele-monitoring should play in the context of heart failure, and to date recommendations are vague. Assess the clinical and medico-economic benefit of an innovative patient monitoring strategy 'AUTONOM @ DOM' is needed.

The primary aim of this study is then to assess a system of home based telemonitoring .The main outcome is unscheduled hospitalisation for heart failure. secondary aims were to assess the efficacy of this system, quality of life and medico-economic benefit.

This pilot study is realised in the Isère and Essonne counties of France. Patients diagnosed with heart failure will be randomized to one of the following groups:

• conventional care including at least a patient education program (ETICS program in Essone county and RESIC38 network in Isere county);
• conventional care, plus home telemonitoring including a recording of the heart rate, blood pressure and weight, remotely transmitted to the cardiologist by an approved validated system that includes an alert monitoring feature.

The study will last one year starting in April 2014.

Inclusion criteria

• Age 60 years or more
• Covered by French social security system or equivalent
• Written informed consent signed by patient
• Heart failure diagnosed by a cardiologue
• NYHA stage II, III or IV
• Able to be followed-up for 1 year
• Attend general healthcare education sessions

Exclusion criteria

• Freedom restricted by judicial order
• Under legal protection
• Require peritoneal dialysis or hemofiltration
• Participation refused by patient, primary care physician or cardiologist
• Present a severe comorbidity with poor short-term prognosis
• Present asymptomatic heart failure NYHA stage I
• Programmed surgical intervention: valve prosthesis or revascularization
• Impossibility to follow a program of patient education
• Residing in medicalized care facility for persons without autonomy
• Residing outside the recruitment zones