To the Editor,
It was with great interest that we read the letter from Llorens et al.1 about the risk profile and predisposing factors leading to hospitalization for heart failure (HF) in the 30 days following a visit to the emergency room for HF.
Our results in the CARME study2 cannot be extrapolated to the population described by Llorens et al. Our study was not conducted in the emergency room context nor following admission in all cases; only a small percentage of patients had required hospitalization in the previous year and recruitment was not immediate. In fact, most participants were outpatients who regularly attended scheduled appointments in the HF unit. This contrasts with other published series that recruited patients immediately following discharge.
Llorens et al.1 reveal the importance of being able to detect the subgroups of patients at greatest risk of readmission. We were unable to identify the patient profile that benefited most from telemonitoring, although our results may indicate that patients with HF who receive better treatment and health education are those who benefit most from telemonitoring–but this remains a speculation. As we recognized when describing the limitations of our study, to determine which patients would benefit more from any specific telemonitoring system we would have needed a broader-based sample that enabled us to conduct subgroup analyses. Although the CARME study2 obtained highly positive results in terms of fewer admissions and fewer days’ hospitalization for HF, the review of the literature on noninvasive telemonitoring showed that results vary; hence the great importance of selecting those patients at higher risk of readmission. For example, the discrepancies between recently published studies (eg, Chaudry et al.3) or conference presentations (eg, the Telemedical Interventional Monitoring in Heart Failure trial4) and the generally positive data described in the Cochrane review.5 The ability to detect the patients at greater risk of readmission does not necessarily imply they are really those who would benefit most from a telemonitoring program. However, subgroup analysis in some studies does suggest those who would benefit most might well be the patients who are most seriously affected. Consequently, although Llorens et al's hypothesis that patients with a history of chronic HF decompensated by precipitating factors like anemia or high blood pressure could benefit more from a telemonitoring program is of interest, more studies are needed to establish precisely which patients should be selected for this type of intervention, and even which type of intervention would most benefit each patient.
FUNDINGDr. Mar Domingo received a grant from Philips to carry out the CARME study and collect the data.
Corresponding author: jlupon.germanstrias@gencat.cat