Telemonitoring in patients with chronic heart failure and COPD.

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often co-exist and are associated with high morbidity and mortality. Telemonitoring (TM) can improve early detection of deterioration and prevent re-admissions. Although telemonitoring is already implemented in several Dutch hospitals for CHF or COPD, care pathways for these conditions are usually separated. Because there is a call for a more holistic approach, we propose a combined TM approach for both diseases in an integrated care pathway.

Telemonitoring in patients with chronic heart failure (CHD) and chronic obstructive pulmonary disease (COPD) might result in improvement of quality of life as compared to usual care.

We conduct a quasi-experimental time-series study in which the main endpoint is assessed every month between during 2.5 years.

During a period of 2 years patients receive a personalized set of sensors for monitoring relevant vital signs (e.g. blood pressure, weight, oxygen saturation, energy expenditure and/or temperature). Sensor data in combination with short questionnaires on clinical status will be uploaded on a digital platform on a regular basis. Data are reviewed in the hospital by a specialized nurse who serves as the patients' case manager. If measurements exceed predefined limits, the cardiologist and pulmonologist are consulted in a multidisciplinary setting on the same day to determine the treatment strategy.