Hartfalen

TELESAT PRIOR-HF: telemonitoring na hartfalenopname verbonden met 46% lagere mortaliteit

Vooraf gespecificeerde subanalyse van de Franse TELESAT-HF-studie bij hartfalenpatiënten met ten minste één hartfalenopname in het voorafgaande jaar. ~1.258 patiënten in een non-invasief telemonitoringprogramma (gemiddeld 73 jaar, 33% vrouw) werden vergeleken met ~2.321 gewogen controles uit de Franse nationale gezondheidsdatabase.

Telemonitoring was geassocieerd met lager risico op all-cause mortaliteit (23,5% vs 39,6%; HR 0,54; 95% BI 0,47–0,63; p<0,001), lagere hartfalenheropnames (rate ratio 0,85; p=0,002), 32% minder SEH-bezoeken, 35% minder IC-opnames en mediaan 1,77 dagen minder ziekenhuisverblijf.

Zorgkosten verschilden niet significant op 6, 12 en 24 maanden. Conclusie: bij hoog-risico patiënten ná hartfalenopname is non-invasieve telemonitoring geassocieerd met sterk verlaagde mortaliteit en zorgconsumptie zonder hogere totale kosten.

Observationeel: confounding niet uit te sluiten ondanks weging. Past in Nederlandse context met groeiende telemonitoringinfrastructuur — waardevolle ondersteuning voor verdere implementatie.

Abstract (original)

Aims: Patients recently hospitalized for heart failure (HF) face a high risk of readmission and mortality. Remote monitoring programs (RMPs) may offer a scalable, non-invasive strategy to improve outcomes in this vulnerable population. Methods: This prespecified sub-analysis of the TELESAT-HF study included HF patients with at least one HF-related hospitalization in the year preceding study entry. Patients enrolled in the RMP and controls were identified from the French national health database. Controls were weighted to create a group comparable to the RMP group. The primary endpoint was all-cause mortality; secondary endpoints included HF rehospitalizations and cumulative days spent in hospital. Healthcare costs were also explored. Results: After weighting, ~1258 patients managed with RMP (mean age 73 years, 33% women) and ~2321 controls were included. Compared with standard of care, RMP was associated with a lower risk of all-cause mortality (23.5% vs. 39.6%; HR 0.54, 95%CI 0.47-0.63; p<.001), a lower rate of HF rehospitalizations (rate ratio 0.85; p=0.002), fewer admissions via emergency departments (-32%), reduced need of intensive care (-35%), and fewer cumulative days spent in hospital (estimated absolute difference -1.77 days; p<.001). Mean total healthcare costs did not differ significantly between groups at 6, 12, or 24 months. Subgroup analyses showed consistent associations across age, sex, RMP modality, and number of prior HF hospitalizations. Conclusion: Among patients recently hospitalized for HF, participation in a non-invasive RMP was associated with lower mortality, fewer HF rehospitalizations, and fewer hospital days, without increasing total healthcare costs.

Dit artikel is een samenvatting van een publicatie in European Journal of Heart Failure. Voor het volledige artikel, alle details en referenties verwijzen wij u naar de oorspronkelijke bron.

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DOI: 10.1093/ejhf/xuag146