E‐health in self‐care of heart failure patients: promises become reality

Abstract

With important gains in mortality achieved through pharmacological and device therapy in patients with heart failure (HF) over the past decade, the focus is increasingly shifting towards reducing recurrences, rehospitalization and therefore optimizing health-related quality of life (HRQoL). HF patients are prepared to trade off longevity for an improvement in HRQoL.1 Meta-analyses of exercise-based cardiac rehabilitation (CR) in patients with HF reported important improvements in HRQoL and a reduction in rehospitalizations,2 and therefore international guidelines consistently recommend group or centre-based CR.3 However, less than 50% of HF patients in Europe actually participate in CR and secondary prevention programmes, prompting a call to identify newer strategies to improve participation and to explore the effectiveness of more accessible alternatives to groupor centre-based interventions.4 Home-based intervention programmes can widen the access and have been shown to be as effective as groupor hospital-based CR after myocardial infarction and coronary revascularization, and with similar costs. In a randomized multicentre trial, participants with HF who received the novel REACH-HF home-based CR intervention for 12 weeks in addition to usual care had superiority in disease-specific HRQoL and self-management at 12 months compared with usual care alone. The cost of the REACH-HF intervention (GBP 418.39 per participant) falls within the National Health Service tariff for CR in England of GBP 477 per patient.5 Self-management interventions could have a beneficial effect on hospitalization, mortality, and HF-related quality of life, an effect that may act through better adherence to evidence-based treatment.6 Incorporation of computing technologies in healthcare (so called e-health) may be particularly patient-friendly as it enables self-care activities at a time and place