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IN-TIME Sees Better Results, Fewer Deaths, With HF Home MonitoringShelley
Wood <http://www.medscape.com/author/shelley-wood>
September 01, 2013




EDITORS' RECOMMENDATIONS

* Home Monitoring for Heart Failure: About TIME
<http://www.medscape.com/viewarticle/812268>




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DRUG & REFERENCE INFORMATION

* Natriuretic Peptides in Congestive Heart Failure
<http://emedicine.medscape.com/article/761722-overview>
* Diuretics and Heart Failure
<http://emedicine.medscape.com/article/2145340-overview>
* Pediatric Congestive Heart Failure
<http://emedicine.medscape.com/article/2069746-overview>



AMSTERDAM ‹ Succeeding where others have failed, the IN-TIME
<http://www.clinicaltrials.gov/ct2/show/NCT00538356?term=IN-TIME&rank=1>
trial has demonstrated that wireless monitoring of implanted devices can
improve heart-failure outcomes.
Dr Gerhard Hindricks (University of Leipzig, Germany) presented IN-TIME to
the press here at the European Society of Cardiology (ESC) 2013 Congress
<http://www.medscape.com/viewcollection/32890> in advance of a hot-line
session later today.
"In-TIME is the first implant-based remote-monitoring randomized
controlled trial demonstrating significant benefits of implant-based home
monitoring for patients with advanced heart failure," Hindricks said.
Indeed, other small studies of heart-failure monitoring have been mixed,
and in two major randomized trials of HF telemedicine came up
empty-handed, prompting one expert to suggest these efforts should be
abandoned.
Just in Time?
All of the devices studied in IN-TIME were made by Biotronik and included
defibrillating cardiac resynchronization therapy (CRT-Ds) devices (58% of
patients) and implantable cardioverter defibrillators (ICDs) (42% of
patients). Patients were also equipped with "Cardio Messenger" systems for
their homes that relayed the data from their implants to a central
monitoring location.
A total of 716 patients were randomized to either home monitoring or a
control group with standard HF care; 82 patients (30 in the
home-monitoring group) terminated the study early due to deaths,
withdrawal of consent, loss to follow-up, or other reasons.
At 12 months, significantly fewer patients in the home-monitoring group
had reached the primary end point, worsening by modified Packer score (a
composite of mortality, overnight hospitalization for worsened HF, and
NYHA class global self-assessment). Moreover, fewer home-monitoring
patients died of any cause over the study period.
Outcomes With Home Monitoring vs Standard Care
End pointHome monitoring (%)Standard care (%)pWorsened HF, by modified
Packer score18.927.5<0.05All-cause mortality3.48.7<0.012
Asked why his study succeeded where others have not, Hindricks called the
Biotronik system "the most advanced implant-based telemonitoring
platform," with studies showing that the "chain of information with this
platform works very, very well.
"All the patient has to do after the implant has been done is plug in the
Cardio Messenger, and from that moment on--and this is really
important--everything works very automatically. Automatic detection of the
signals, automatic transmission--the patient does nothing. This is one of
the differences with other telemonitoring applications. Whenever you
involve patients, the likelihood that the chain of information, which is
crucial, doesn't work appropriately is very, very high."
Commenting on the study for heartwire , Dr Mariell Jessup (University of
Pennsylvania, Philadelphia) also highlighted the lack of patient
involvement.
"I think probably the difference in this trial is that the patients didn't
have to do anything special," she said. "They were having ongoing
monitoring, whether they wanted it or not. And we'll have to understand
more what components of that really translated into being such a
beneficial outcome, what kinds of interventions were made, did this make
people feel better, were there more trips to the hospital? We don't have
all that data."
To heartwire , Hindricks said that the results from IN-TIME would be easy
to translate to individual clinics, because of the highly automated nature
of the process. "We have more than 1000 patients at Heart Center Leipzig
using home monitoring, we have specially trained nursing staff who go to
the website and analyze the patients, the patients are in electronic
files, you don't see the patients without events, and you set the event
triggers according to study protocol or according to the individual needs
or requirements of the patients."
When a patient has an event that warrants further investigation, these are
flagged in the morning, and the physician can instigate follow-up. "It is
not that difficult. . . . It can be easily copied."
Hindricks disclosed receiving study grants, educational grants, and
honoraria from Biotronik.



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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Margaret Vugrin, MSLS, AHIP
Reference Librarian
Texas Tech University Health Sciences Library
3601 4th, MS7781
Lubbock, TX 79430

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On 11/20/2013, 10:25 AM, "Vugrin, Margaret" <[log in to unmask]>
wrote:

>What about:  
>http://cp.mcafee.com/d/5fHCN8e3zqbbP1EVso7czztPqqb2bzxEVd7bXNJd5x5MtuVEVpd
>FEI8Ke6zAQsLCzASzuXzNEVsKYUrlS97o_fzbp6cE0GsSOtbtW3pKsSOtbtW3pKXOvSujvW_fT
>jd7aafnKnjhusVVd-WqvbnhIyCGyyDOEuvkzaT0QSyrhdTVeZXTLuZXCXCM0iLEkJGTYLxCnCd
>zelz_NV6XdPhOrGoxYiWLE7O85PM2GX4zIvC0kKpr8NB00E1pPr9QI0kLW3oafBivdCluZ1ISU
>Nt4S2_id40nYZoQgig-4VeBFg8Cy3jh17o8llAauwq89NBFVEwbCy0Aq80S4Va-rKrPHKV
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
>
>
>Margaret Vugrin, MSLS, AHIP
>Reference Librarian
>Texas Tech University Health Sciences Library
>3601 4th, MS7781
>Lubbock, TX 79430
>
> <mailto:[log in to unmask]>[log in to unmask]
>P 806-743-2241
>F 806-743-2218
>
>
>
>
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>If you need reference assistance please send an email to
>[log in to unmask]
>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
>"Privacy/Confidentiality Notice: This message, including any attachments,
>is for the sole use of the intended recipient(s) and may contain
>confidential and privileged information. Any unauthorized review, use
>disclosure or distribution is strictly prohibited. If you are not the
>intended recipient, please contact the sender by reply email and destroy
>all copies of the original message."
>
>
>
>
>
>
>
>On 11/20/2013, 10:22 AM, "Lisa McCormick" <[log in to unmask]> wrote:
>
>>Dear Colleagues, a customer provided scant information for me to locate
>>articles on a randomized controlled trial conducted in Europe related to
>>"wireless medicine" or m-health.  I searched Clinical Trials.gov using
>>wireless & mhealth; I searched PubMed with variations of "Intime" and
>>searched on randomized controlled trials and remote monitoring, etc.
>>
>> 
>>
>>My hope is that one of you might recognize "Intime" and help me connect
>>it to the correct spelling or acronym.
>>
>> 
>>
>>Kind regards,
>>
>> 
>>
>>Lisa McCormick, MSLS, AHIP
>>
>>Health Sciences Library
>>
>>The Jewish Hospital
>>
>>llmccormickathealth-partners.org
>>