Impact of telemedical management on hospitalization and mortality in heart failure patients with diabetes: a post-hoc subgroup analysis of the TIM-HF2 trial

Cardiovascular Diabetology, vol. 23, pp. 198

Abstract

BACKGROUND: The TIM-HF2 study demonstrated that remote patient management (RPM) in a well-defined heart failure (HF) population reduced the percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death during 1-year follow-up (hazard ratio 0.80) and all-cause mortality alone (HR 0.70). Higher rates of hospital admissions and mortality have been reported in HF patients with diabetes compared with HF patients without diabetes. Therefore, in a post-hoc analysis of the TIM-HF2 study, we investigated the efficacy of RPM in HF patients with diabetes. METHODS: TIM-HF2 study was a randomized, controlled, unmasked (concealed randomization), multicentre trial, performed in Germany between August 2013 and May 2018. HF-Patients in NYHA class II/III who had a HF-related hospital admission within the previous 12 months, irrespective of left ventricular ejection fraction, and were randomized to usual care with or without added RPM and followed for 1 year. The primary endpoint was days lost due to unplanned cardiovascular hospitalization or due to death of any cause. This post-hoc analysis included 707 HF patients with diabetes. RESULTS: In HF patients with diabetes, RPM reduced the percentage of days lost due to cardiovascular hospitalization or death compared with usual care (HR 0.66, 95% CI 0.48-0.90), and the rate of all-cause mortality alone (HR 0.52, 95% CI 0.32-0.85). RPM was also associated with an improvement in quality of life (mean difference in change in global score of Minnesota Living with Heart Failure Questionnaire score (MLHFQ): - 3.4, 95% CI - 6.2 to - 0.6). CONCLUSION: These results support the use of RPM in HF patients with diabetes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01878630.

Authors 16

1. Friedrich Koehler corresponding

   Humboldt-Universität zu Berlin · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin · Deutsches Herzzentrum der Charité

   Affiliation as printed

   Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany. friedrich.koehler@dhzc-charite.de

   Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. friedrich.koehler@dhzc-charite.de

   German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany. friedrich.koehler@dhzc-charite.de

   Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany

2. Johanna Koehler

   Technical University of Munich · TUM Klinikum

   Affiliation as printed

   Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany

3. Peter Bramlage

   IPPMed (Germany)

   Affiliation as printed

   Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany

4. Eik Vettorazzi

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

5. Karl Wegscheider

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

6. Susanne Lezius

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Institute of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

7. Sebastian Spethmann

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin · Deutsches Herzzentrum der Charité

   Affiliation as printed

   Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

   Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany

8. Roman Iakoubov

   Technical University of Munich · TUM Klinikum

   Affiliation as printed

   Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany

9. Anjaly Vijayan

   IPPMed (Germany)

   Affiliation as printed

   Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany

10. Sebastian Winkler

    Unfallkrankenhaus Berlin

    Affiliation as printed

    Clinic for Internal Medicine and Cardiology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany

11. Christoph Melzer

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin · Deutsches Herzzentrum der Charité

    Affiliation as printed

    Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany

    Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

12. Katharina S. Schütt Aachen Department of Internal Medicine I (Cardiology)

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Germany

13. Cécile Dessapt-Baradez

    Sanofi (United Kingdom)

    Affiliation as printed

    , Sanofi, Reading, UK

    Sanofi, Reading, UK

14. W. Dieter Paar
    Affiliation as printed

    Sanofi-Aventis Deutschland GmbH, Berlin, Germany

15. Kerstin Koehler

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin · Deutsches Herzzentrum der Charité

    Affiliation as printed

    Centre for Cardiovascular Telemedicine, Deutsches Herzzentrum der Charité (DHZC), Charitéplatz 1, 10117, Berlin, Germany

    Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

16. Dirk Müller‐Wieland Aachen Department of Internal Medicine I (Cardiology)

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Germany