Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial
| Autor: | Trine S Bergmo, Jo Middlemass, Ramon Farré, Andrei Malinovschi, Dorjan Marušič, Christer Janson, Giulia Munaro, Roberto Rosso, Ruth Sepper, Pasquale P. Pompilio, Josep M. Montserrat, Kaiu Prikk, Peter M.A. Calverley, Paul Walker, Silvana Šonc, Raffaele Dellaca, A Niroshan Siriwardena, Paolo Zanaboni |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty A300 Clinical Medicine Exacerbation Psychological intervention Critical Care and Intensive Care Medicine law.invention Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Health care B710 Community Nursing medicine Humans 030212 general & internal medicine Medical prescription Lung Aged Monitoring Physiologic COPD business.industry medicine.disease Telemedicine Clinical trial 030228 respiratory system Heart failure Female business |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine. 198:620-628 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/rccm.201712-2404oc |
| Popis: | Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily, and in a subgroup with congestive heart failure (n = 37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions.Primary outcomes were time to first hospitalization (TTFH) and change in the EuroQoL EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescription; hospitalization; the COPD Assessment Tool, Patient Health Questionnaire-9, and Minnesota Living with Heart Failure questionnaire scores; quality-adjusted life years; and healthcare costs. Telemonitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. In an exploratory analysis, telemedicine was associated with fewer repeat hospitalizations (-54%; P = 0.017).In older patients with COPD and comorbidities, remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registered with www.clinicaltrials.gov (NCT 01960907). |
| Databáze: | OpenAIRE |
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