====== LuHF - Luxembourg Heart Failure ====== {{:project:luhf1.jpg?300 |Luhf}} **Epidemiological background**\\ Congestive heart failure (CHF) has become a health problem of epidemic proportion in the western world. CHF affects 5,000 – 10,000 people in the Grand Duchy of Luxembourg and is the leading cause of hospital admission for patients over 65. Current medical therapy has only a modest effect on morbidity, mortality and quality of life. Better methods of secondary prevention are needed urgently. Recent studies have shown that re-admission, length of stay and hospital charges are significantly decreased when home monitoring systems will be applied to CHF patients [1]. It is assumed that reduced re-admission rates will also have a positive effect on the quality of life. **Objectives**\\ Our multidisciplinary research project will improve the currently available methods of home monitoring for CHF and assesses its health economic impact in five different steps: - Determination of practical physiologic parameters (e.g. blood pressure, ECG, weight) to be measured non-invasively by the patient himself. - Set up of a tailor-made home monitoring system adapted to the needs of patients with CHF. - Development of a data transfer and evaluation system to analyze the patient’s health status at distance. - Conducting of a randomized clinical trial to compare a group of home-monitored patients to a group of conventional treated patients. - Analyse the effects of home monitoring in CHF on Quality of Life (QoL) and Health Care Costs **Expected Results**\\ The Luxembourg Heart Failure Project (LuHF) aims to develop a home monitoring system, able to improve the quality of life of CHF patients as well as reducing their hospital stay. One important requirement is that elderly and disabled patients may use this system easily. A health economic evaluation based on a randomised clinical trial should prove, if a home monitoring system is an encouraging way to lower health care costs and to improve quality of life. **Description and context**\\ Public health relevance: Patients with CHF report a considerably reduced quality of life because of physical symptoms and functional disability. Today, the most effective therapy for end-stage CHF is cardiac transplantation. However, because of limited donor organ supply, transplantation is limited to younger patients. This leads to poor prognosis and frequent hospitalizations combined with emotional and economic burdens. The EPICAL study shows annual re-admission rates of 2.5 hospitalisations per patient and 27.6 hospital days per year [2]. McMurray estimates a CHF prevalence rate of up to 13% for people over 65. Due to the increasing average age of the western population, these are major contributors to rising health-care costs. The American Heart Association has estimated that the hospital costs per discharge are about 14,000 US$ per CHF patient [2]. A recent study has indicated that home-based intervention with visiting nurses can decrease the rate of re-admissions and associated health-care costs. Two recent studies have shown that hospitalisations can be reduced if CHF patients are monitored on weight, heart rate and blood pressure. The potential impact of a home monitoring system on health care costs and quality of life is considerable. Unfortunately most initiatives have been funded as biomedical development projects without systematic analysis of health care costs. Therefore our multidisciplinary research project LuHF should improve the currently available methods of home monitoring for CHF patients and assess its economic usefulness. Based on these results, new implementation strategies of cost effective tele-health care services could be developed. It is our hypothesis that well-adopted home monitoring systems will improve the quality of life for patients with congestive heart failure by reducing hospital stays and the need to urgent re-admissions. **Methods**\\ In the first part of the project, a set of physiological parameters was determined that might be usable for a computer aided analyse of the patients health status. It is required, that all measurements could be done at the patient’s home without the help of a health professional. We have realised that not a single system was available on the market, which fulfils all these requirements and have decided to develop our own home monitoring system, called MonICard (Monitoring Instrument for Cardiology). Here we measure daily an Electrocardiogram (ECG) synchronic to the patient’s oxygen saturation (SPO2). These parameters are supplemented by non-invasive blood pressure (NIBP) and weight. Our patent pending analysis method interprets these parameters and computes an estimation of the patient’s health status. First results with a limited number of in-patients have shown that our estimation method helps the cardiologist to recognize early health fluctuations and allows him to adjust the pharmaceutical therapy accordingly. This should save the patient from emergency hospitalisations and life threatening situations. By using the method of an health economic evaluation, we estimate the effects of home-monitoring on quality of life and health care costs, This evaluation will be based on a randomised clinical trial. The CHF Patients (NYHA Class III-IV) will be recruited by the Division of Cardiology at the Centre Hospitalier de Luxembourg. A qualified nurse and a cardiologist will review patient data on a daily basis. If necessary, patient treatment will be adapted during outpatient’s appointments. Events such as death, readmissions and hospitals days will be recorded. **Products developed in the project**\\ {{:project:monicardhomesystem.jpg?200|Monicard Home System}} {{:project:monicardprof.jpg?200|}} **Contact**\\ [[team:harpes]], [[team:roesch]] **Publications and Patents**\\ Wagner, Daniel; Rösch, Norbert; Kindermann Ingrid: Pulstransitzeit, Ein neuer Parameter zur telemedizinischen Überwachung bei Herzinsuffizienz, EHEALTHCOM (2) S.58-60, 2007 Rösch, Norbert; Wagner, Daniel; Harpes Patrick: The Luxembourg Heart Failure Project, A new concept of tele-homemonitoring for CHF patients to support managed care programs, Proceedings of the MEDETEL Conference, 2006 Rösch, Norbert; Harpes, Patrick; Wagner, Daniel, Plumer, Pierre: Non Invasive Heart Monitoring Apparatus and Method, European Patent Office, Patent number EP 1776039, 2006 Dominique, Tom; Rösch, Norbert; Wagner Daniel: Implementation of an Home monitoring Study, The Luxembourg Heart failure Project, Proceedings of the MEDETEL Conference, 2002 **References **\\ [1] Bondmass M, Bolger N. et al. The Effect of Physiologic Home Monitoring and Telemanagement on Chronic Heart Failure Outcomes. The Internet Journal of Advanced Nursing Practice Vol 3N2, 1999\\ [2] Zannad F, Braincon S et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study. J Am Coll Cardiol Vol 33:734-742; 1999\\ [3] Heidenreich PA, Ruggerio CM, Massie BM. Effect of a home monitoring system on hospitalization and resource use for patients with heart failure. Am Heart J 1999;138:633-640\\ [4] Shah, N.B. et al (1998). Prevention of Hospitalisations for heart failure with an interactive home monitoring program, American Heart Journal 135 (3), 373-37 ** Spin-Off **\\ The LuHF project team created a Spin-Off in 2005 to bring the results to the market. Please visit [[http://www.monitor-it.lu|Monitor-It]].