Intérêt de la télésurveillance non invasive dans le contrôle du poids, des symptômes et la réduction des hospitalisations chez les patients insuffisants cardiaques : analyse d'une cohorte française sur 1 an

Abstract

Background

Heart failure (HF) is a severe condition associated with high rates of hospitalization and mortality. Early outpatient detection of symptoms and weight gain through remote medical monitoring of HF (HF-RM) could improve patient prognosis.

Objectives

To evaluate the effectiveness of HF-RM in managing congestion in HF outpatients and to analyze event rates over 12 months (HF-related hospitalizations and all-cause mortality), as well as associated costs.

Methods

We included patients enrolled in the HF-RM at our hospital from July 2020 to December 2022. For each patient, HF-RM relied on daily transmission of weight and symptoms via a connected scale. Any alerts related to weight gain or the onset of new symptoms were managed within 48 hours by the specialized HF team, including a telephone contact, NT-proBNP testing, and treatment adjustment if necessary. Data on HF-related hospitalizations and vital status were collected over a 12-month period before and after the implementation of HF-RM. Event rates were compared to expected values at the onset of HF-RM, based on patient profiles and data from the ESC-HF-LT registry. Cost analysis included costs associated with HF-RM, the specialized HF nurse, biological tests, and HF hospitalizations.

Results

Among the 147 patients included, the average age was 60 ± 12 years, and 75% were male. The average ejection fraction (EF) was 33 ± 11%, with 76% of patients presenting with reduced EF. During the HF-RM period, 85 alerts (54% of patients) led to a significant reduction in weight and symptoms within 30 days. The hospitalization rate decreased from 44.9% before the initiation of HF-RM to 11.6% afterward (p < 0.0001). The 12-month event rate was 15%, significantly lower than the expected 24.5% (p = 0.0002). The absence of transmitted alerts was strongly correlated with the absence of events (negative predictive value of 95.2%). The number of days spent at home increased, and costs significantly decreased.

Conclusion

HF-RM is associated with improved outpatient congestion control, reduced hospitalizations, and decreased healthcare costs. Further prospective, randomized studies are needed to better assess the impact of HF-RM on the progression of HF and its costs.