Luxembourg Heart Failure

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imageCongestive heart failure (CHF) has become a major health-care problem. CHF is the leading cause of hospital admission for patients over age 65. Current medical therapy has only a modest effect on morbidity and mortality in patients with CHF. Characteristic features of patients with CHF are frequent hospital admissions and low quality of life. Re-admissions of patients with CHF are a major contributor to health-care costs.

Two recent studies have shown that re-admissions can be reduced when CHF patients self-monitor weight, heart rate and blood pressure, and communicate with a nurse-monitor. Important parameters of cardiac function such as cardiac output and peripheral vascular resistance can be determined through analysis of the pulse pressure curve. Recent technological advances have opened new possibilities of monitoring: the pulse pressure curve now can be obtained non-invasively with a special blood pressure cuff and the data could be transferred via a home-monitoring system to the central unit and allow the cardiologist to control his CHF patients at a distance. However, such a monitoring study has not been done yet and it is unclear what patients may benefit most from such a surveillance. Patients with CHF typically have dilatation of the left ventricle with functional mitral regurgitation (MR). The dynamic nature of MR has recently been documented with exercise-echocardiography where MR increased with exercise in some patients. Anecdotal observations suggest that those patients have a poor prognosis and may therefore have the greatest benefit from home-monitoring.

Methods

In the first part of the project, the accuracy of pulse pressure recording and analysis of special blood pressure cuffs will be determined in patients with CHF undergoing cardiac catheterization for clinical purposes. The most accurate and cost-effective system will be selected and a data transfer system will be developed. At the same time, the prognostic implications of exercise-induced MR will be studied in patients with CHF using supine bicycle exercise-echocardiography. Exercise echocardiography may be useful to select a subgroup of CHF patients, which may have the greatest benefit from home-monitoring. Alternatively, patients admitted with CHF functional class NYHA III-IV can be taken as a target population. In the second part of the project, the effect of home-monitoring on quality of life and health care costs will be studied in patients with severe CHF. It is our hypothesis that home-monitoring in CHF will improve quality of life, reduce re-admissions and admissions to the intensive care unit, and allow early discharge.

Specific aims

  • To measure blood pressure, cardiac output and peripheral resistance non-invasively in patients with CHF using a pulse contour method
  • To set-up a data transfer system for home-monitoring of blood pressure, cardiac output and peripheral resistance in CHF patients
  • To compare a group of home-monitored CHF patients to a group of non-monitored patients with respect to hospital re-admissions, admissions to intensive care units and early discharge
  • To analyze the effect of home-monitoring in CHF on quality of life and health care costs
  • To assess whether there is a correlation between exercise-induced changes in mitral regurgitant volume and clinical outcome in CHF