A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility Trial

Christophe Jp Smeets, Valerie Storms, Pieter M Vandervoort, Pauline Dreesen, Julie Vranken, Marita Houbrechts, Hanne Goris, Lars Grieten, Paul Dendale, Christophe Jp Smeets, Valerie Storms, Pieter M Vandervoort, Pauline Dreesen, Julie Vranken, Marita Houbrechts, Hanne Goris, Lars Grieten, Paul Dendale

Abstract

Background: European Society of Cardiology guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin-converting enzyme inhibitors (ACE-I) and β-blockers to the maximum-tolerated, evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies have shown that they are insufficiently implemented in clinical practice.

Objective: The aim of this study was to verify whether supplementing the usual care with the CardioCoach follow-up tool is feasible and safe, and whether the tool is more efficient in implementing the guideline recommendations for β-blocker and ACE-I.

Methods: A total of 25 HF patients were randomly assigned to either the usual care control group (n=10) or CardioCoach intervention group (n=15), and observed for 6 months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semiautomatic remote medication uptitration. Remote monitoring sensors automatically transmit patient's blood pressure, heart rate, and weight on a daily basis.

Results: Patients' satisfaction and adherence for medication intake (10,018/10,825, 92.55%) and vital sign measurements (4504/4758, 94.66%) were excellent. However, the number of technical issues that arose was large, with 831 phone contacts (median 41, IQR 32-65) in total. The semiautomatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although no significant differences were found between both groups, a higher number of patients were on guideline-recommended medication dose in both groups compared with previous reports.

Conclusions: The CardioCoach follow-up tool for remote uptitration is feasible and safe and was found to be efficient in facilitating information exchange between care providers, with high patient satisfaction and adherence.

Trial registration: ClinicalTrials.gov NCT03294811; https://ichgcp.net/clinical-trials-registry/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM).

Keywords: call centers; clinical decision support; drug monitoring; drug utilization; heart failure; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Christophe JP Smeets, Valerie Storms, Pieter M Vandervoort, Pauline Dreesen, Julie Vranken, Marita Houbrechts, Hanne Goris, Lars Grieten, Paul Dendale. Originally published in JMIR Cardio (http://cardio.jmir.org), 04.04.2018.

Figures

Figure 1
Figure 1
Overview of the CardioCoach follow-up tool.
Figure 2
Figure 2
Overview of the study protocol for both the CardioCoach intervention group and usual care control group. ACE-I: angiotensin-converting enzyme inhibitors; BW: blood withdrawal.
Figure 3
Figure 3
The number of patients on maximum daily dose as recommended by European Society of Cardiology guidelines for both β-blockers (left) and ACE-I (right). No significant differences were observed between both groups. ACE-I: angiotensin-converting enzyme inhibitors.

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