Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM‐HF2 trial

Aims The TIM‐HF2 study showed less days lost due to unplanned cardiovascular hospitalization or all‐cause death and improved survival in patients randomly assigned to remote patient management (RPM) instead of standard of care. Methods and results This substudy explored whether the biomarkers mid‐re...

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Published in:European journal of heart failure 2019-11, Vol.21 (11), p.1445-1458
Main Authors: Möckel, Martin, Koehler, Kerstin, Anker, Stefan D., Vollert, Jörn, Moeller, Volker, Koehler, Magdalena, Gehrig, Stefan, Wiemer, Jan C., Haehling, Stephan, Koehler, Friedrich
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Language:English
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Digital health
MR‐proADM
NT‐proBNP
Outcome
Remote patient management
Telemedicine
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cited_by cdi_FETCH-LOGICAL-c3600-e5a6f2b04091bb0621e0a8c0ae7005461c70eff39e8f55e898adf400c87e3f4a3
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container_end_page 1458
container_issue 11
container_start_page 1445
container_title European journal of heart failure
container_volume 21
creator Möckel, Martin
Koehler, Kerstin
Anker, Stefan D.
Vollert, Jörn
Moeller, Volker
Koehler, Magdalena
Gehrig, Stefan
Wiemer, Jan C.
Haehling, Stephan
Koehler, Friedrich
description Aims The TIM‐HF2 study showed less days lost due to unplanned cardiovascular hospitalization or all‐cause death and improved survival in patients randomly assigned to remote patient management (RPM) instead of standard of care. Methods and results This substudy explored whether the biomarkers mid‐regional pro‐adrenomedullin (MR‐proADM) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) could be used to identify low‐risk patients unlikely to benefit from RPM, thereby allowing more efficient allocation of the intervention. For 1538 patients of the trial (median age 73 years, interquartile range 64–78 years, 30% female), baseline biomarkers were used to select subpopulations recommended for RPM with various safety endpoints (100%, 98%, 95% sensitivity), and efficacy of RPM was assessed. Both biomarkers were strongly associated with events. The primary endpoint of lost days increased from 1.0% (1.4%) in the lowest to 17.3% (17.6%) in the highest quintile of NT‐proBNP (MR‐proADM). After combining biomarkers to identify patients recommended for RPM with 95% sensitivity, in the most efficient scenario (excluding 27% of patients; NT‐proBNP
doi_str_mv 10.1002/ejhf.1530
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Methods and results This substudy explored whether the biomarkers mid‐regional pro‐adrenomedullin (MR‐proADM) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) could be used to identify low‐risk patients unlikely to benefit from RPM, thereby allowing more efficient allocation of the intervention. For 1538 patients of the trial (median age 73 years, interquartile range 64–78 years, 30% female), baseline biomarkers were used to select subpopulations recommended for RPM with various safety endpoints (100%, 98%, 95% sensitivity), and efficacy of RPM was assessed. Both biomarkers were strongly associated with events. The primary endpoint of lost days increased from 1.0% (1.4%) in the lowest to 17.3% (17.6%) in the highest quintile of NT‐proBNP (MR‐proADM). After combining biomarkers to identify patients recommended for RPM with 95% sensitivity, in the most efficient scenario (excluding 27% of patients; NT‐proBNP &lt; 413.7 pg/mL and MR‐proADM &lt; 0.75 nmol/L), the effect of RPM on patients was highly similar to the original trial (ratio of lost days: 0.78, hazard ratio for all‐cause death: 0.68). Number needed to treat for all‐cause death was lowered from 28 to 21. Rates of emergencies and telemedical efforts were significantly lower among patients not recommended for RPM. Biomarker guidance would have saved about 150 h effort/year per 100 patients of the eligible population. Conclusions The combined use of MR‐proADM and NT‐proBNP may allow safe, more precise, effective and cost‐saving allocation of patients with heart failure to RPM and warrants further prospective studies.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.1530</identifier><identifier>PMID: 31129929</identifier><language>eng</language><publisher>Oxford, UK: John Wiley &amp; Sons, Ltd</publisher><subject>Digital health ; MR‐proADM ; NT‐proBNP ; Outcome ; Remote patient management ; Telemedicine</subject><ispartof>European journal of heart failure, 2019-11, Vol.21 (11), p.1445-1458</ispartof><rights>2019 The Authors. © 2019 European Society of Cardiology</rights><rights>2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3600-e5a6f2b04091bb0621e0a8c0ae7005461c70eff39e8f55e898adf400c87e3f4a3</citedby><cites>FETCH-LOGICAL-c3600-e5a6f2b04091bb0621e0a8c0ae7005461c70eff39e8f55e898adf400c87e3f4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31129929$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Möckel, Martin</creatorcontrib><creatorcontrib>Koehler, Kerstin</creatorcontrib><creatorcontrib>Anker, Stefan D.</creatorcontrib><creatorcontrib>Vollert, Jörn</creatorcontrib><creatorcontrib>Moeller, Volker</creatorcontrib><creatorcontrib>Koehler, Magdalena</creatorcontrib><creatorcontrib>Gehrig, Stefan</creatorcontrib><creatorcontrib>Wiemer, Jan C.</creatorcontrib><creatorcontrib>Haehling, Stephan</creatorcontrib><creatorcontrib>Koehler, Friedrich</creatorcontrib><title>Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM‐HF2 trial</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims The TIM‐HF2 study showed less days lost due to unplanned cardiovascular hospitalization or all‐cause death and improved survival in patients randomly assigned to remote patient management (RPM) instead of standard of care. Methods and results This substudy explored whether the biomarkers mid‐regional pro‐adrenomedullin (MR‐proADM) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) could be used to identify low‐risk patients unlikely to benefit from RPM, thereby allowing more efficient allocation of the intervention. For 1538 patients of the trial (median age 73 years, interquartile range 64–78 years, 30% female), baseline biomarkers were used to select subpopulations recommended for RPM with various safety endpoints (100%, 98%, 95% sensitivity), and efficacy of RPM was assessed. Both biomarkers were strongly associated with events. The primary endpoint of lost days increased from 1.0% (1.4%) in the lowest to 17.3% (17.6%) in the highest quintile of NT‐proBNP (MR‐proADM). After combining biomarkers to identify patients recommended for RPM with 95% sensitivity, in the most efficient scenario (excluding 27% of patients; NT‐proBNP &lt; 413.7 pg/mL and MR‐proADM &lt; 0.75 nmol/L), the effect of RPM on patients was highly similar to the original trial (ratio of lost days: 0.78, hazard ratio for all‐cause death: 0.68). Number needed to treat for all‐cause death was lowered from 28 to 21. Rates of emergencies and telemedical efforts were significantly lower among patients not recommended for RPM. Biomarker guidance would have saved about 150 h effort/year per 100 patients of the eligible population. 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After combining biomarkers to identify patients recommended for RPM with 95% sensitivity, in the most efficient scenario (excluding 27% of patients; NT‐proBNP &lt; 413.7 pg/mL and MR‐proADM &lt; 0.75 nmol/L), the effect of RPM on patients was highly similar to the original trial (ratio of lost days: 0.78, hazard ratio for all‐cause death: 0.68). Number needed to treat for all‐cause death was lowered from 28 to 21. Rates of emergencies and telemedical efforts were significantly lower among patients not recommended for RPM. Biomarker guidance would have saved about 150 h effort/year per 100 patients of the eligible population. 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source Wiley:Jisc Collections:Wiley Read and Publish Open Access 2024-2025 (reading list)
subjects Digital health
MR‐proADM
NT‐proBNP
Outcome
Remote patient management
Telemedicine
title Biomarker guidance allows a more personalized allocation of patients for remote patient management in heart failure: results from the TIM‐HF2 trial
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