PROGNOSTIC VALUE OF TELEPHONE MONITORING BASED ON RISK ASSESSMENT OF ACUTE HEART FAILURE DECOMPENSATION IN PATIENTS WITH LOW LEFT VENTRICULAR EJECTION FRACTION

Highlights

• The main cause of death in patients with heart failure with low left ventricular ejection fraction is its acute decompensation.
• Remote outpatient monitoring of patients with low left ventricular ejection fraction, based on telephone monitoring aimed at assessing early symptoms of fluid retention, can significantly reduce the incidence of acute decompensation of heart failure and emergency hospitalizations.

Background. The results of registry studies indicate that the main cause of death in patients with heart failure with low left ventricular ejection fraction (LVEF) is acute decompensation of heart failure (EDF).

Aim. To evaluate the results of outpatient remote monitoring using a calculator for assessing the risk of CHF in patients with NSFV.

Methods. 65 patients with CNFV who were observed at the HF Center were randomized into a telephone monitoring group (TM) and a control group. The TM group consisted of 35 patients aged 63.2 (52; 71) years, 30 (85.7%) men, LVEF 29.7 (24.3;36.7)%, the control group consisted of 30 patients with CNnF, aged 65.1 (54; 73) years, 19 (63.3%) men, LVEF 33.1 (26.8; 39.1)%. The compared groups were comparable in terms of gender, age, LVEF, and therapy. A monthly telephone survey was conducted in the TM group using a special questionnaire aimed at detecting early symptoms of fluid retention and acute cardiovascular events. The results of the survey were recorded in a patented calculator program for determining the risk of acute respiratory failure. Depending on the number of points scored, the risk of CHF was assessed as very high, high, moderately elevated, and low, which implied certain medical decisions (calling an ambulance, making an appointment with a doctor, increasing the dose of a diuretic, continuing prescribed treatment). The control group was observed by a cardiologist without undergoing TM. To evaluate the results of using the calculator, the frequency of development of CHF, acute coronary syndrome (ACS), hospitalizations and deaths in the compared groups was analyzed during two years of follow-up.

Results. During the follow-up period, cases of CHF were significantly less frequent in the TM group compared with the control group, 14 (40%) vs. 21 (70%), p = 0.031; emergency hospitalizations, both primary, 18 (51.4%) vs. 6 (17.1%), p = 0.033, and repeated, 24 (80%) vs. 16 (46.7%), p = 0.005; ACS, 9 (25.7%) vs. 16 (53.3%), p = 0.043. Planned hospitalizations, on the contrary, were more often registered in the main group, in 12 (34.3%) and 5 (16.7%) patients, respectively, p = 0.049. There were no differences in deaths between the groups: 1 (2.8%) vs. 2 (6.6%, p = 0.466.

Conclusion. Remote outpatient follow-up of patients with acute heart failure, based on telephone monitoring aimed at assessing the risk of acute decompensation of heart failure, can significantly reduce the risk of developing heart failure and the frequency of emergency hospitalizations.

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