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Feasibility and effectiveness of a multidimensional post-discharge disease management programme for heart failure patients in clinical practice: the HerzMobil Tirol programme

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Abstract

Aims

It remains unclear whether transitional care management outside of a clinical trial setting provides benefits for patients with acute heart failure (AHF) after hospitalization. We evaluated the feasibility and effectiveness of a multidimensional post-discharge disease management programme using a telemedical monitoring system incorporated in a comprehensive network of heart failure nurses, resident physicians, and secondary and tertiary referral centres (HerzMobil Tirol, HMT),

Methods and results

The non-randomized study included 508 AHF patients that were managed in HMT (n = 251) or contemporaneously in usual care (UC, n = 257) after discharge from hospital from 2016 to 2019. Groups were retrospectively matched for age and sex. The primary endpoint was time to HF readmission and all-cause mortality within 6 months. Multivariable Cox proportional hazard models were used to assess the effectiveness. The primary endpoint occurred in 48 patients (19.1%) in HMT and 89 (34.6%) in UC. Compared with UC, management by HMT was associated with a 46%-reduction in the primary endpoint (adjusted HR 0.54; 95% CI 0.37–0.77; P < 0.001). Subgroup analyses revealed consistent effectiveness. The composite of recurrent HF hospitalization and death within 6 months per 100 patient-years was 64.2 in HMT and 108.2 in UC (adjusted HR 0.41; 95% CI 0.29–0.55; P < 0.001 with death considered as a competing risk). After 1 year, 25 (10%) patients died in HMT compared with 66 (25.7%) in UC (HR 0.38; 95% CI 0.23–0.61, P < 0.001).

Conclusions

A multidimensional post-discharge disease management programme, comprising a telemedical monitoring system incorporated in a comprehensive network of specialized heart failure nurses and resident physicians, is feasible and effective in clinical practice.

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Acknowledgements

We thank our patients for participation in the HMT programme; the specialized HF nurses M Braunegger, T Forsthuber, I Fringer, M Hohengasser, D Kathrein, M Kreidl, V Massinger, W Neyer, M Ortner, T Ritter-Waltl, C Schlierenzauer for high-quality patient treatment; the network physicians R Eiter, R Erhart, P Faber, T Fluckinger, H Gänzer, C Gebhart, C Gelsinger, W Grander, W Gritsch, N Gruber, I Haffner, D Heininger, G. Henle, F Kirchmeyr, K Kirchmeyr, C Krismer, M Kufner, P Kufner, S Hoschek, S Huter, B Joosten-Gstrein, M Kahler, U Köllensperger, G Ladner, C Mattle-Schmid, K Moosburger, M Müller, S Nemec, M Radi, R Rieger, D Ritelli, A Süssenbacher, A Wiseman, D Wildauer, E Wöll, M Zangerle-Schmid for excellent patient care and nurse supervision; the helpdesk teams at telbiomed Medizintechnik und IT Service GmbH and of AIT Austrian Institute of Technology for technical support and constant training; the Landesinstitut für integrierte Versorgung, Tirol, and Tirol Kliniken GmbH, in particular in the person of P Lechleitner, for the provision of the infrastructure; the Federal State of Tyrol, in particular in the person of State Councillor for Health B Tilg, for continued support.

Funding

HMT was funded by Tiroler Wissenschaftsfonds from 2012 to 2014 and by the Tyrolean Health Fund from 2014 to 2017 and was finally adopted into regular service in March 2017. T Egelseer-Bründl was supported by the Landesinstitut für Integrierte Versorgung, Tirol.

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Correspondence to G. Poelzl.

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392_2021_1912_MOESM1_ESM.ppt

Supplementary file1 Figure 1S: Bar plot distribution of recurrent heart failure hospitalizations per patients at risk (a) and the cumulative percentage of death events (b) over time. UC = usual care, HMT = HerzMobil Tirol (PPT 144 kb)

Supplementary file2 (DOC 47 kb)

Supplementary file3 (DOC 33 kb)

Supplementary file4 (DOC 35 kb)

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Poelzl, G., Egelseer-Bruendl, T., Pfeifer, B. et al. Feasibility and effectiveness of a multidimensional post-discharge disease management programme for heart failure patients in clinical practice: the HerzMobil Tirol programme. Clin Res Cardiol 111, 294–307 (2022). https://doi.org/10.1007/s00392-021-01912-0

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  • DOI: https://doi.org/10.1007/s00392-021-01912-0

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