Telemedical management of symptomatic COVID-19 outpatients.

Autor:	von Falkenhausen AS; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Geipel S; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany., Gail A; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany., Scherer C; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Stockhausen S; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Sams LE; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Becker F; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Doldi PM; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Lemmermöhle E; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany., de Villèle P; Withings, Issy-les-Moulineaux, France., Schleef M; MVZ Sonnen-Gesundheitszentrum, Munich, Germany., Becker M; Labor Becker, Munich, Germany., Lauterbach M; SaniPlus Apotheken, Munich, Germany., Massberg S; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany., Kääb S; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.; These authors share senior authorship., Sinner MF; Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.; German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.; These authors share senior authorship.
Jazyk:	angličtina
Zdroj:	ERJ open research [ERJ Open Res] 2024 Aug 12; Vol. 10 (4). Date of Electronic Publication: 2024 Aug 12 (Print Publication: 2024).
DOI:	10.1183/23120541.00277-2024
Abstrakt:	Background: COVID-19 remains a challenge to individual health and healthcare resources worldwide. Telemedical surveillance might minimise hospitalisation and direct patient-physician contacts. Yet, randomised clinical trials evaluating telemedical management of COVID-19 patients are lacking. Methods: COVID-SMART is a randomised, open-label, controlled clinical trial investigating whether telemedicine reduces the primary end-point of hospitalisation or any unscheduled utilisation of an emergency medical service within 30 days of follow-up. Key secondary end-points included mortality and primary end-point components. We enrolled acutely infected SARS-CoV-2 patients suitable for outpatient care. All presented with ≥1 risk factor for an adverse COVID-19 course. Patients were randomised 1:1 into a control group receiving standard of care and an intervention group receiving smartphone-based assessment of oxygen saturation, heart rate and electrocardiogram, and telemedical counselling via a 24/7 emergency hotline. Results: Of 607 enrolled patients (mean±sd age 46.7±13.5 years), 304 were randomised into the intervention and 303 into the control group. The primary end-point occurred in 6.9% (n=21) of the intervention and in 9.6% (n=29) of the control group (hazard ratio (HR) 0.72, 95% confidence interval (CI) 0.41-1.26; p=0.24). No deaths occurred during follow-up. Fewer intervention group participants utilised outpatient-based emergency medical services (HR 0.43, 95% CI 0.20-0.90; p=0.03). Conclusions: COVID-SMART is the first randomised clinical trial assessing the benefit of telemedicine in an acute respiratory infectious disease. Whereas telemedical management did not reduce the primary end-point of hospitalisation, fewer intervention group patients used outpatient-based emergency services, suggesting a potential benefit for less-acutely infected individuals. Competing Interests: Conflict of interest: A.S. von Falkenhausen declares to be granted support from the German Research Foundation. Conflict of interest: C. Scherer reports speaker honoraria from AstraZeneca outside the submitted work. Conflict of interest: P. de Villèle reports being an employee of Withings, the manufacturer of Scanwatch, the smart watch that was used in this trial. Conflict of interest: M.F. Sinner declares being granted support from the German Centre for Cardiovascular Research and with travel support from Biotronik. Conflict of interest: All other authors declare no potential conflict of interest. (Copyright ©The authors 2024.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu