Remote Management of Renal Function May Reduce Mortality, HF Hospitalizations

A new trial has found that patient management through remote means could reduce all-cause mortality and hospitalizations for heart failure (HF) in patients with renal impairment.

Patients with heart failure (HF) and renal impairment may see an improvement in all-cause mortality and hospitalizations for HF when using remote patient management (RPM), according to a study published in Frontiers in Medicine.

The prospective, randomized, controlled, parallel group, unmasked, multicenter trial took place in Germany from 2013 to 2017. Patients were included if they had New York Heart Association functional class II or III stable HF, had hospital admission due to worsening HF within 12 months of randomization, were on a guideline-directed medical therapy with maximum left ventricular ejection fraction (LVEF) of 45%, or were taking diuretics and had an LVEF of 45% or higher.

Patients were assigned to 1 of 2 cohorts: RPM plus usual care (n = 765) or usual care alone (n = 773). Study visits were secheduled with each patient's general practitioner or local cardiologist at 3, 6, and 9 months. The final study visit took place between 365 and 393 days after randomization, and 671 patients in the RPM group and 669 in the usual care group took part in that final visit.

The RPM intervention comprised a daily review of transmitted vital parameters (eg, weight, blood pressure, electrocardiogram, peripheral capillary oxygen saturation, self-rated health status), patient education, and cooperation between the telemedicine center and the general practitioner and cardiologist.

"Patients in the usual care group were followed up in accordance with the current guidelines for HF management," the authors noted.

There were 878 (57.1%) patients who had impaired renal function (glomerular renal function [eGFR] < 60 mL/min/1.73 m2) at randomization and 660 (42.9%) patients who had an eGFR of at least 60 mL/min/1.73 m2.

Patients with impaired renal function had a mean (SD) eGFR of 42 (11) mL/min/1.73 m2 vs 78 (13) mL/min/1.73 m2 in patients with better renal function. These patients were also older, were less frequently male, had a lower body mass index, and had more comorbidities. Distribution of patients with eGFR of less than 60 and 60 or more was balanced due to randomization.

The researchers found significantly reduced all-cause mortality in the RPM group compared with the usual care group: 61 (8.0%) patients in the RPM group and 89 (11.5%) patients in the usual care group died. Patients with eGFR below 60 in the RPM group also had a lower mortality rate, with 48 (11.1%) patients vs 74 (16.6%) patients in the usual care group dying, representing a 33% reduction (incidence rate ratio [IRR], 0.67; 95% CI, 0.47-0.96). The difference was not found in patients with an eGFR of 60 or higher.

Patients with an eGFR below 60 had a higher 1-year-survival if they were in the RPM group compared with the usual care group, at 89.4% vs 84.6%, and patients with an eGFR of 60 or above had similar 1-year-survival in both groups.

Study analyses also show that patients with an eGFR below 60 had lower incident rates of recurrent HF hospitalizations (IRR, 0.74) and recurrent HF hospitalizations and all-cause mortality (IRR, 0.70) in the RPM group compared with the usual care group. HF hospitalizations (IRR, 0.60), HF hospitalizations plus all-cause mortality (IRR, 0.64), and HF hospitalizations and cardiovascular death (IRR, 0.61) were all lower in the RPM group. Both groups saw a decline of eGFR.

There were some limitations to this study. Renal end points were not specified, and renal events were not reported separately. Also, the intervention was specified for the German health care system.

The researchers concluded that RPM could reduce all-cause mortality and HF in hospitalizations in patients with HF who had an eGFR of less than 60 ml/min/1.73 m2, and they added that "further prospective study for a primary analysis, including other renal outcomes and biomarkers, is needed for further evaluation."

Reference

Naik MG, Budde K, Koehler K, et al. Remote patient management may reduce all-cause mortality in patients with heart-failure and renal impairment. Front Med (Lausanne). Published online July 11, 2022. doi:10.3389/fmed.2022.917466