Abstract 17680: A Comparison of Primary Care, Home-Based Telemonitoring, Telemonitoring with Video, or Specialist Directed Heart Failure Clinic Care for Patients with High Risk Heart Failure
Bibliographic record
Abstract
Introduction: Most studies of telephone-based care for heart failure (HF) patients have not integrated primary care providers at the initial point of care. Further, the addition of video assessment to telemonitoring has not been studied. We aimed to evaluate, in heart failure outpatients, the safety and feasibility of a telephone-based monitoring system with involvement of primary care providers compared to the gold-standard heart failure clinic model. Methods: Patients with a heart failure and at least one hospitalization within the previous six months were randomized in a 1:1:1 fashion to either usual care in a nurse-managed heart failure clinic with cardiologist backup (UC), or a daily telemonitoring system, with standard phone (TM) or video (TV) capability. The latter two groups additionally underwent biweekly scripted telephone (TM) or videophone (TV) calls. Protocol-based interventions with involvement of primary care provider were utilized. The primary outcome was the composite total mortality and hospitalization at 12 months follow up. Results: There were 122 patients (44 to UC, 38 to TM and 40 to TV), with 100% follow up. The median age was 67 years, 35% were female, mean EF was 46% and median NT-pro-BNP was 2211 pg/ml. The primary endpoint of occurred in 40 (or 33%) of patients and was not different between the three groups (UC 14, TM 12, and TV 14 events respectively, p= 0.81). Additionally, no difference in death (UC 4, TM 2, TV 4, p= 0.65) or total hospitalitzations were seen (UC 20, TM 17, TV 21, p= 0.75). Conclusions: A home telemonitoring strategy with primary care provider involvement appears to be a safe and feasible alternative to care in a specialist led heart failure clinic for patients with ambulatory heart failure. The addition of video capability is unlikely to provide a major impact. Further, properly powered studies are justified in order to establish the relative benefits of this strategy as a routine treatment modality for heart failure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".