TY  - JOUR
AU  - Smeets, Christophe JP
AU  - Storms, Valerie
AU  - Vandervoort, Pieter M
AU  - Dreesen, Pauline
AU  - Vranken, Julie
AU  - Houbrechts, Marita
AU  - Goris, Hanne
AU  - Grieten, Lars
AU  - Dendale, Paul
PY  - 2018
DA  - 2018/04/04
TI  - A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility Trial
JO  - JMIR Cardio
SP  - e8
VL  - 2
IS  - 1
KW  - heart failure
KW  - telemedicine
KW  - clinical decision support
KW  - drug monitoring
KW  - drug utilization
KW  - call centers
AB  - 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://clinicaltrials.gov/ct2/show/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM) 
SN  - 2561-1011
UR  - http://cardio.jmir.org/2018/1/e8/
UR  - https://doi.org/10.2196/cardio.9153
UR  - http://www.ncbi.nlm.nih.gov/pubmed/31758773
DO  - 10.2196/cardio.9153
ID  - info:doi/10.2196/cardio.9153
ER  -