Nicht implantatbasiertes Telemonitoring
Tóm tắt
Zur Verlaufsbeobachtung von Herzinsuffizienzpatienten stehen multiple Parameter zur Verfügung, deren Assoziation zu klinischer Verschlechterung mit nötiger Krankenhausbehandlung und Sterberisiko gut dokumentiert ist. Die Frage, ob die longitudinale Beobachtung dieser Parameter durch nicht implantatbasiertes Telemonitoring zu stabileren klinischen Verläufen von Herzinsuffizienzpatienten mit selteneren Krankenhausbehandlungen und geringerer Sterblichkeit führt, ist noch nicht endgültig geklärt, auch wenn sich ein günstiger Effekt abzubilden scheint. Die divergenten Studienergebnisse verweisen darauf, dass sowohl die Methodik des Telemonitorings als auch die Charakteristika der Zielpopulation für die Größe des möglichen protektiven Effekts bedeutsam sind. Nicht geeignet scheint die Anwendung eines automatischen Telefonanrufbeantworters, während differenziertere und personalisierte Ansätze erfolgreicher sein könnten. Auch die Definition klar strukturierter therapeutischer Interventionen als Reaktion auf spezifische beobachtete Parameterkonstellationen ist vermutlich bedeutsam. Durch Telemonitoring begleitete Patienten scheinen insbesondere im Anschluss an eine hydropische Dekompensation der Herzinsuffizienz zu profitieren. Die Telemedical Interventional Management in Heart Failure II (TIM-HF II) Studie (clinicaltrials.gov Identifier NCT01878630) randomisiert aktuell 1500 Patienten nach stationär behandelter kardialer Dekompensation auf telemedizinisches Management vs. konventionelle Herzinsuffizienztherapie. Ergebnisse dieser Studie sind vermutlich Mitte 2018 zu erwarten und werden wichtigen weiteren Aufschluss geben.
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