Telemonitoring in heart failure improves cardiometabolic risk-factor control: real-world signals of enhanced adherence
T Aguiar, C Costa, I Cruz, M Silva, S Carvalho, J Ribeiro, J M Bastos, A BriosaAbstract
Background
Telemonitoring (TM) improves outcomes in chronic heart failure (HF), but real-world evidence on whether TM also supports patient activation and treatment adherence beyond congestion management remains limited.
Aim
To assess whether a HF TM pathway is associated with improved adherence/patient activation, using changes in cardiometabolic risk-factor control (LDL-cholesterol, HbA1c) and smoking status as pragmatic surrogates, while also describing concomitant changes in healthcare utilization and functional status.
Methods
Retrospective before–after analysis of 31 consecutive HF patients enrolled in a TM program. Outcomes were compared within patients over the 12 months before versus after TM initiation. Endpoints included hospitalizations, days hospitalized, emergency department (ED) visits, NYHA class, diuretic dose, biomarkers, lipid profile, glycaemic control (diabetic subgroup), smoking status, and LVEF. Multivariable models explored baseline predictors of improvement.
Results
Patients were predominantly male (77%), mean age 67 years, with high cardiovascular risk burden (hypertension 61%, dyslipidaemia 74%, diabetes 36%); mean LVEF 34% and ischaemic etiology 81%. The most frequent TM alert was weight gain (59%); 67% of alerts were resolved without in-person assessment. After TM initiation, there were mean reductions in hospitalizations (−0.7; SD 0.95) and admission days (−5.8; SD 11.0), ED visits (−0.3; SD 1.4), and NYHA class (−0.4; SD 0.7), alongside an increase in LVEF (+6.4%; SD 8.4). Improvements were statistically significant for hospitalizations (p<0.01), days hospitalized (p<0.01), NYHA class (p<0.01), and LVEF (p<0.01). LDL levels decreased by −30.6 mg/dL (SD 51.9; p<0.01). HbA1c levels decreased by −0.6 %-points (SD 0.8; p<0.05) among patients with diabetes (n=11). Current smoking decreased from 5/31 (16.1%) pre-TM to 2/31 (6.5%) at 12 months, with 3/5 (60%) baseline smokers achieving cessation. In multivariable analysis, greater benefit clustered in patients with higher pre-TM event burden (more prior hospitalizations/longer admissions/more advanced symptoms and lower LVEF).
Conclusions
In a real-world HF TM cohort, TM was associated with fewer admissions and improved NYHA class and LVEF, with the largest gains in clinically advanced/high-utilization patients. Beyond clinical stabilization, TM coincided with improved cardiometabolic risk-factor control (LDL, HbA1c) and smoking cessation, supporting a potential additional value through enhanced adherence/patient engagement. Prospective studies should confirm whether TM-driven patient activation translates into sustained adherence improvements and long-term outcomes.