Telemonitoring in chronic heart failure not unqualifiedly positive often additional demand for care without decreasing number of admissions

To contain rising healthcare costs, digitization of healthcare is often seen as a solution. Researchers at the Radboudumc examined the use of telemonitoring in chronic heart failure. Does this reduce hospital admissions and visits to the emergency room? Sometimes it does, but often not. Sometimes the demand for care and costs even increase. More insight is needed if telemonitoring is to be introduced successfully.

Healthcare costs are rising fast, and in time they will be impossible to meet. Digital healthcare is often seen as a way to limit these rising costs. Researchers at the Radboudumc examined whether this premise is correct using a concrete example: telemonitoring for chronic heart failure. This is not entirely coincidental, as in many 'Western' countries one to two percent of the healthcare budget is spent on this condition. In the Netherlands, where almost a quarter of a million people suffer from chronic heart failure, 30,000 hospital admissions were recorded in 2017. The total care costs for this patient group amounted to 817 million euros.

Remote monitoring

Monitoring the patient at home via digital systems (telemonitoring) is based on the assumption that deterioration of the patient's condition will be detected earlier. This also makes it possible to intervene earlier - with adjustments to medication, for example - so that hospital admissions and visits to the emergency room (ED) are less frequent. That sounds logical, but is it really the case in practice?

Increased demand for care

Based on a systematic review, Stefan Auener, researcher at IQ healthcare of the Radboudumc, concluded that this is usually not the case. Telemonitoring does not show a decrease in the number of hospital admissions in most cases. And in the vast majority of cases, it does not seem to have an effect on the number of emergency room visits. However, there is a wide variety of telemonitoring programs, a minority of which do show clear savings in care use and care costs. "A striking finding is that the majority of studies show an increase in other care use, such as outpatient visits. This is really still understudied and raises many questions that need to be further investigated" says Patrick Jeurissen, Professor of Affordability of Care at the Radboudumc.

Filtering out success factors

The researchers' general conclusion is that the effects of telemonitoring on healthcare costs are still very unclear, and often even contradictory. Most likely this is due to the large variation in telemonitoring programs and target populations. Further research will have to focus more on the how and why of these differences, so that it becomes clear which criteria a successful introduction of telemonitoring must meet. Only in this way can telemonitoring contribute to reducing healthcare costs.

About the publicatie

Publication in Journal of medical internet research: The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review - Stefan L Auener, Toine E P Remers, Simone A van Dulmen, Gert P Westert, Rudolf B Kool, Patrick P T Jeurissen.

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