Implementation Study of Accelerated Heart Failure Guideline-Directed Medical Therapy in a General Cardiology Clinic - TEAM-HF

Published Congress: HFA 2024

Link: https://pubmed.ncbi.nlm.nih.gov/27818309/

Dr. Zeynep Pelin Orhan

Background:

Heart failure is a disease that causes significant morbidity, mortality and health care costs.
Approximately 27% of medical care patients hospitalized for heart failure are readmitted within 30 days. To date, interventions aimed at reducing heart failure readmissions have had several outcomes. In heart failure, medication adherence is crucial for controlling symptoms, delaying disease progression and preventing hospitalization. Unfortunately, up to 50% of heart failure patients have poor adherence, suggesting that adherence interventions could reduce readmissions. Telemonitoring, defined as the use of communication technology to monitor clinical status in chronically ill patients, has not consistently improved outcomes in heart failure patients. However, to our knowledge, telemonitoring adherence to heart failure medications has not yet been investigated. TEAM-HF study is a pilot randomized trial that evaluating the feasibility of telemonitoring of medication adherence in recently hospitalized heart failure patients.

Objective:

The aim of this study was to test the feasibility of telemonitoring medication adherence in heart failure patients.

Methods:

40 patients hospitalized for heart failure included in the TEAM-HF study were randomized to 30-day adherence monitoring of a loop diuretic with telephone support for nonadherence or passive adherence monitoring only.83% of the eligible patients, agreed to participate in the study. The median age was 64 years, 25% were female and 45% were Hispanic.

Results:

Across all patients included in this study, 67% of patients were nonadherent (percentage of days with the correct number of doses <88%). There was no difference in adherence (median correct dose adherence 82% vs. 73%; p = 0.41) or readmission rate within 30 days (30% vs. 20%; p = 0.72) between patients in the intervention and passive monitoring groups, respectively. 88% of patients rated the wireless electronic adherence device as somewhat or very easy to use. 88% of patients agreed to use it again.

Conclusion:

This study showed us that adherence telemonitoring is acceptable for most heart failure patients. It shows that medication non-adherence, especially with loop diuretics, is common even when patients know they were being monitored, but it is possible to monitor adherence remotely.

Interpretations:

It was observed that adherence telemonitoring, which is used in the follow-up of chronic diseases, can also be used in the follow-up of heart failure patients. Although medication non-adherence is common, it is promising that adherence to treatment will increase in the long term due to the possibility of remote monitoring of patients.