Rapid titration of carvedilol in patients with congestive heart failure: a randomized trial of automated telemedicine versus frequent outpatient clinic visits.
Rapid titration of carvedilol in patients with congestive heart failure: a randomized trial of automated telemedicine versus frequent outpatient clinic visits.
复制标题
充血性心力衰竭患者卡维地洛的快速滴定：自动远程医疗与频繁门诊就诊的随机试验。
DOI：
10.1016/j.ahj.2005.06.044
复制
发表时间：
2006
影响因子：
4.8
通讯作者：
Kasper,EdwardK
中科院分区：
文献类型：
--
作者：
Spaeder,Jeffrey;Najjar,SamerS;Gerstenblith,Gary;Hefter,Gail;Kern,Linda;Palmer,JamesG;Gottlieb,SheldonH;Kasper,EdwardK
由于潜在的副作用和滴定药物的后勤困难，充血性心力衰竭的门诊患者很少接受适当剂量的卡维地洛或其他β受体阻滞剂。为了解决这些障碍，我们研究了一个自动化的远程医疗系统，名为TeleWatch（TW），可以促进卡维地洛滴定在门诊患者左心室收缩功能不全。METHODS四十九例纽约心脏协会II级和III级左心室收缩功能不全，谁是容忍适当的后负荷降低治疗，不接受β受体阻滞剂，被纳入一个3个月的研究。患者随机接受仅临床（CO）（n = 24）卡维地洛滴定或结合临床访视和TW监测的滴定（n = 25）。所有患者每两周在门诊就诊，TW组患者每天进行远程监测。使用预定义的算法，CO组和TW组的患者分别有资格接受两周或每周一次的卡维地洛滴定，由对组分配不知情的医生进行。由于远程远程医疗滴定与临床滴定一样成功，TW组达到卡维地洛最终剂量的时间显著缩短（33.6 vs 63.7天，P <0.0001）。有5个严重的不良事件在研究中，其中4个是在TW组（P = .29），然而，TW前瞻性地检测到2个不良事件。CONCLUSIONSRemote监测与自动远程医疗系统可以成功地促进卡维地洛滴定在门诊患者与纽约心脏协会II级和III级充血性心力衰竭。
BACKGROUNDBecause of potential side effects and logistical difficulty of titrating medications, outpatients with congestive heart failure rarely receive appropriate doses of carvedilol or other β-blockers. To address these obstacles, we studied if an automated telemedicine system named TeleWatch (TW) could facilitate carvedilol titration in outpatients with left ventricular systolic dysfunction.METHODSForty-nine patients with New York Heart Association class II and III left ventricular systolic dysfunction, who were tolerating appropriate afterload-reducing therapy and not receiving β-blockers, were enrolled into a 3-month study. Patients were randomized to have clinic-only (CO) (n = 24) carvedilol titration or titrations which combined clinic visits with TW monitoring (n = 25). All patients were seen in clinic biweekly, and those in the TW group were remotely monitored daily. Using a predefined algorithm, patients in the CO and TW groups were eligible for carvedilol titration on a biweekly or weekly basis, respectively, by physicians blinded to group assignment.RESULTSThere was no statistical difference in the mean final daily dose of carvedilol between the CO and TW groups (39.4 vs 36.2 mg/d, P = .52). Because remote telemedicine titrations were as successful as titrations in the clinic, the time to reach the final dose of carvedilol was significantly shorter in the TW group (33.6 vs 63.7 days, P < .0001). There were 5 serious adverse events in the study, 4 of which were in the TW group (P = .29); however, TW prospectively detected 2 adverse events.CONCLUSIONSRemote monitoring with an automated telemedicine system can successfully facilitate titration of carvedilol in outpatients with New York Heart Association class II and III congestive heart failure.