Effect of telemedicine on health-related quality of life in patients with heart failure: insights from the iCOR randomised controlled trial

Abstract Background/introduction Heart failure (HF) can negatively affect health-related quality of life (HRQoL) in HF patients by reducing their independence and limiting their daily activities. Patient-reported outcome measures (PROMs), such as HRQoL, are useful indicators to health status and have good correlation with prognosis. In the past years the addition of telemedicine (TM) to HF programmes has emerged as a promising strategy for the management of chronic HF patients. However, there is little information about the impact of TM on HRQoL. Purpose To determine the effect of a TM-based intervention on HRQoL of high-risk chronic HF patients compared to usual care (UC). Methods We performed a sub-analysis of the "Insuficiència Cardíaca Optimització Remota" (iCOR) study focusing on HRQoL. iCOR was a single centre, randomised, controlled trial, designed to evaluate a TM intervention added to an existing nurse-based, hospital/primary care multidisciplinary, integrated programme for high-risk chronic HF patients. Participants were randomised to TM or UC after hospital discharge ("vulnerable-phase") and were followed for 6 months. The primary study endpoint for the current analysis was the delta change of HRQoL after 6 months of follow-up, assessed using Minnesota Living with Heart failure Questionnaire (MLHFQ). Impaired HRQoL was considered when patient scored > 55 points. To assess the change in HRQoL between the 2 groups, a repeated-measures ANOVA analysis was performed, adjusted for baseline HRQoL. Results 178 patients with HF were analysed (81 TM vs 97 UC). The median age of the patients was 74±11 years, 41% were female and 57% had preserved ejection fraction. As shown in figure 1, HRQoL was poor at baseline (median score of 55±20 points in TM vs 59±19 points in UC) and was not different between both groups (p-value > 0.05). Although both groups showed an improvement in HRQoL after 6 months of follow-up (p-value 0.001 for time effect), HRQoL improved significantly more in the TM-based intervention group (from 55±20 to 14±15, mean Delta change= -37.9±26.4) than in UC group (from 59±19 to 23±21, mean delta change = -29.7±29.1, p-value 0.008) (Figure 1). We designed several multivariate linear regression models exploring the determinants of HRQoL at baseline and the determinants of change in HRQoL over time. As shown in Table 1, HRQoL at baseline, cognitive function (MMSE [mini-mental state examination] and Pfeiffer), affective status and randomisation arm were the only independent predictors of improvement of HRQoL over time. Conclusions The addition of TM to a standard HF programme is effective in improving HRQoL in high risk patients with chronic HF regardless cognitive function, affective status or frailty.HRQoL status changeDeterminants of HRQoL