Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: The Weight Monitoring in Heart Failure (WHARF) trial

被引:262
作者
Goldberg, LR
Piette, JD
Walsh, MN
Frank, TA
Jaski, BE
Smith, AL
Rodriguez, R
Mancini, DM
Hopton, LA
Orav, EJ
Loh, E
机构
[1] Univ Penn, Div Cardiovasc Med, Heart Failure & Cardiac Transplant Program, Philadelphia, PA 19104 USA
[2] VA Ctr Practice Management & Outcomes Res, Ann Arbor, MI USA
[3] Univ Michigan, Ann Arbor, MI 48109 USA
[4] Indiana Univ, St Vincents Hosp, Indianapolis, IN 46204 USA
[5] Sanger Clin PA, Charlotte, NC USA
[6] Sharp Mem Hosp & Rehabil Ctr, San Diego Cardiac Ctr, San Diego, CA USA
[7] Emory Univ, Div Cardiol, Atlanta, GA 30322 USA
[8] Chestnut Hill Cardiol, Flourtown, PA USA
[9] Columbia Univ, Div Circulatory Physiol & Cardiol, New York, NY USA
[10] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA
[11] Wyeth Ayerst Res, Philadelphia, PA USA
关键词
D O I
10.1016/S0002-8703(03)00393-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure, but data to support this practice are locking. Using a technology-based heart failure monitoring system, we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline-driven heart failure care. Methods This was a randomized, controlled trial. Patients hospitalized with New York Heart Association class III or IV heart failure, with a left ventricular ejection fraction less than or equal to35% were randomized to receive heart failure program care or heart failure program care plus the AlereNet system (Alere Medical, Reno, Nev) and followed-up for 6 months. The primary end point was 6-month hospital readmission rate. Secondary end points included mortality, heart failure hospitalization readmission rate, emergency room visitation rate, and quality of life. Results Two hundred eighty patients from 16 heart failure centers across the United States were randomized: 138 received the AlereNet system and 142 received standard care. Mean age was 59 +/- 15 years and 68% were male. The population had very advanced heart failure, New York Heart Association class III (75%) or IV-(25%), as evidenced by serum norepinepherine levels, 6-minute walk distance and outcomes. No differences in hospitalization rates were observed. There was a 56.2% reduction in mortality (P <.003) for patients randomized to the AlereNet group. Conclusions This is the largest multicenter, randomized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure. Despite no difference in the primary end point of rehospitalization rates, mortality was significantly reduced for patients randomized to the AlereNet system without an increase in utilization, despite specialized and aggressive heart failure care in both groups.
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收藏
页码:705 / 712
页数:8
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