Home-based telemonitoring care and executive function in patients with heart failure.

Abstract

Enhancement of self-care ability is essential for patients with heart failure (HF), and executive function plays a critical role. We investigated the clinical influence of a home-based remote care program using telemonitoring and telecoaching on executive function in patients with HF and assessed the relationship between executive functional status and clinical outcomes. This prospective study enrolled outpatients with HF, and they received home-based remote care program with telemonitoring and telecoaching using self-measured physical data. Executive function was assessed using the Trail Making Test Part B (TMT-B). The incidences of HF hospitalization and all-cause death were also compared according to baseline executive function status based on TMT-B test performance. Forty-one participants were enrolled in this study (mean age: 64.8 ± 13.8 years; male 68.3%; New York Heart Association [NYHA] class II/III: 78.0/22.0%). Twelve months after the initiation of the program, TMT-B significantly improved (p = 0.039), accompanied by an obvious amelioration of HF symptoms as assessed by the NYHA class (p = 0.027). During a median follow-up of 20.5 months, the incidence of HF hospitalization was significantly higher in patients with executive dysfunction than in those without (hazard ratio: 4.97, 95% confidence interval: 1.15-21.4, p = 0.031). This was unchanged even in a subcohort without cognitive dysfunction, as assessed using the Mini-Mental State Examination. Telemonitoring and telecoaching at home may be effective in improving executive function in patients with HF. Further studies are needed to assess whether supportive care assisting executive functioning improves clinical outcomes in patients with HF.