Influence of Home Monitoring on the Clinical Status of Heart Failure Patients With an Impaired Left Ventricular Function
- Conditions
- Ventricular FibrillationCongestive Heart FailureVentricular Tachycardia
- Interventions
- Device: ICD or CRT-D with Home Monitoring feature deactivatedDevice: ICD or CRT-D with Home Monitoring feature activated
- Registration Number
- NCT00538356
- Lead Sponsor
- Biotronik SE & Co. KG
- Brief Summary
Re-hospitalizations or deaths by worsening heart failure are often preceded by distinct trends of clinical parameters such as atrial or ventricular arrhythmia, activity, heart rate variability, or ventricular ectopy. The Home Monitoring™ capability offered by BIOTRONIK active implants has the potential to detect some of these trends early and thus to offer the possibility to intervene in time for prevention of fatal worsening of heart failure.
To investigate the predictive value of Home Monitoring parameters, patients with symptomatic heart failure and reduced ejection fraction receiving an implantable cardioverter-defibrillator (ICD) or an ICD in combination with cardiac resynchronization therapy (CRT-D) will be randomized between prospective patient management by Home Monitoring analysis or standard care. The influence of Home Monitoring on the clinical status of heart failure patients will be assessed.
- Detailed Description
Hospital admissions or deaths by worsening heart failure are often preceded by distinct trends of clinical parameters such as heart rhythm disturbances, daily physical activity of a patient, or mean heart rates.
The Home Monitoring™ capability offered by many BIOTRONIK implants has the potential to detect some of these trends early. During Home Monitoring surveillance, medical and technical data from an ICD or CRT device are sent to a modified mobile phone, the so-called Cardio Messenger. This device transmits the data via a mobile phone network to the BIOTRONIK service center. There, the data are put into an easily accessible form and can then be viewed by the physician online via the internet on a secure website. Additionally, the occurrence of heart rhythm disturbances or device problems will be transmitted by fax, SMS or email.
This unique system allows the attending physician to monitor each patient very closely and to react early enough to prevent worsening of heart failure at an early stage, to optimize therapy, and to secure the correct functioning of the implant.
The goal of IN-TIME is thus to analyze the impact of a regular Home Monitoring evaluation on the health status of heart failure patients receiving such an implant as part of their therapy.
A total of 720 patients with heart failure symptoms and a severely reduced pumping function receiving an ICD or a CRT-D device from up to 50 European clinical centers will be enrolled into the study. About 4 weeks after discharge from the implanting hospital, patients will be randomly assigned to prospective patient management by Home Monitoring or standard care groups. Patients in the Home Monitoring group will be monitored at least once per week, patients in the control group will not be monitored during the study, but their transmitted Home Monitoring data will be analyzed after their ending of participation in the study.
The health status of patients will be measured using the well established "Packer Score". This score is a combined measurement of death rates, hospital admission rates, heart failure symptom classification and quality of life. Patients will be classified at their end of study participation as worsened, unchanged, or improved based on these parameters. To this end, the health status of participating patients will be determined regularly during further outpatient follow ups. These will take place at regular intervals due to the standard care.
Additionally, some special parameters sent to the physician via Home Monitoring will be analyzed whether they could possibly predict an imminent worsening of a patient's health - leading to an unplanned hospital visit - so that it could perhaps be prevented in the future.
Patients remain within the study for 12 months after randomization or until their participation is ended prematurely, e.g. by withdrawal of their consent, a low data transmission rate, or death.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 720
- Indication for single chamber ICD, dual chamber ICD or CRT-D
- Chronic heart failure (≥ 3 months)
- NYHA Class II or III for 1 month prior to screening
- LVEF ≤ 35% within 3 months prior to screening
- Indication for therapy with diuretics
- Patient informed consent
- Uncontrolled hypertension
- NYHA class I or IV
- Permanent atrial fibrillation
- Life expectancy < 1 year
- Restrictive, infiltrative or hypertrophic cardiomyopathy, constrictive pericarditis, acute myocarditis
- Severe mitral regurgitation
- Symptomatic aortic stenosis
- Tricuspid valve replacement
- Known drug or alcohol abuse
- Expected non-compliance
- Pregnancy
- Participation in another telemonitoring concept
- Participation in another study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Control ICD or CRT-D with Home Monitoring feature deactivated ICD or CRT-D with Home Monitoring feature deactivated Patients will be treated as per standard of care in each participating clinic Home Monitoring ICD or CRT-D with Home Monitoring feature activated ICD or CRT-D with Home Monitoring feature activated Home Monitoring data will be analyzed regularly and patients will be contacted and scheduled for additional follow-up after predefined events
- Primary Outcome Measures
Name Time Method Composite Score of death, hospitalization for heart failure, NYHA class and global assessment (Packer Score) 12 months
- Secondary Outcome Measures
Name Time Method Rehospitalizations due to worsening heart failure; Correlation of Home Monitoring values with the clinical status; Incidence and reasons for Home Monitoring based interventions; Home Monitoring workflow analysis 12 months
Trial Locations
- Locations (39)
Hospital Na Homolce
🇨🇿Praha, Czech Republic
Gentofte Hospital
🇩🇰Hellerup, Denmark
Herzzentrum der Universität Leipzig
🇩🇪Leipzig, Germany
Institute of Clinical and Experimental Medicine
🇨🇿Praha, Czech Republic
Universitätsklinik für Innere Medizin
🇦🇹Innsbruck, Austria
Universitätsklinikum Charité Campus Benjamin Franklin
🇩🇪Berlin, Germany
Vivantes Humboldt Klinikum
🇩🇪Berlin, Germany
Städtische Kliniken Bielefeld
🇩🇪Bielefeld, Germany
Universitätsklinikum Gießen und Marburg
🇩🇪Gießen, Germany
Medizinische Hochschule
🇩🇪Hannover, Germany
St. Marienhospital Lünen GmbH
🇩🇪Lünen, Germany
Klinikum St. Georg gGmbH
🇩🇪Leipzig, Germany
Kardiologische Gemeinschaftspraxis Dr. Mühling
🇩🇪München, Germany
Klinikum Pirna GmbH
🇩🇪Pirna, Germany
Århus Universitetshospital, Skejby Sygehus
🇩🇰Århus N, Denmark
Vivantes Klinikum am Urban
🇩🇪Berlin, Germany
Zentralklinik Bad Berka
🇩🇪Bad Berka, Germany
Universitätsklinik Schleswig-Holstein
🇩🇪Lübeck, Germany
Sydney Adventist Hospital
🇦🇺Wahroonga, Australia
Aalborg Hospital
🇩🇰Aalborg, Denmark
Odense Universitets Hospital
🇩🇰Odense, Denmark
Klinikum Coburg gGmbH
🇩🇪Coburg, Germany
Chaim Sheba Medical Center
🇮🇱Tel-Hashomer, Israel
Herz- und Gefäßklinikum Bad Neustadt GmbH
🇩🇪Bad Neustadt, Germany
Vivantes Klinikum Neukölln
🇩🇪Berlin, Germany
Klinikum Lippe-Detmold
🇩🇪Detmold, Germany
Bad Segeberger Kliniken GmbH
🇩🇪Bad Segeberg, Germany
P. Stradins Clinical University Hospital, Latvian Centre of Cardiology
🇱🇻Riga, Latvia
Rabin Medical Center
🇮🇱Petach-Tikva, Israel
Universitätsklinikum Bonn
🇩🇪Bonn, Germany
Westdeutsches Herzzentrum des Universitätsklinikums Essen
🇩🇪Essen, Germany
Universitätsklinikum des Saarlandes
🇩🇪Homburg/Saar, Germany
Klinikum Schwabing, Kardiologie
🇩🇪Munich - Schwabing, Germany
Barzilai Medical Center
🇮🇱Ashkelon, Israel
Stiftsklinik Augustinum, Innere Medizin / Kardiologie
🇩🇪München, Germany
Kardiologische Gemeinschaftspraxis Dr. Predel, Dr. Heinrich
🇩🇪Nordhausen, Germany
Klinikum der Universität München Großhadern
🇩🇪München, Germany
Herzzentrum München-Bogenhausen
🇩🇪München, Germany
St. Vincenz Krankenhaus GmbH
🇩🇪Paderborn, Germany