Evaluation of Survival, Care Pathway, and Associated Costs of Telemonitored Heart Failure Patients and Comparison With a Control Group

OBJECTIVES: Patients with chronic heart failure (CHF) are frequently hospitalized, with over 150,000 hospitalizations per year in France. The aim of this study was to evaluate the management of TM patients and compare it with non-TM patients.

METHODS: A retrospective observational study was conducted using SNDS database. All patients with CHF using Newcard device for at least 3 months between 2017 and 2020 were included. A control group with CHF was randomly selected and matched 1:3 with TM patients by year of inclusion, age and sex, and using a propensity score adjusted for the following variables: social disadvantage index, presence of comorbidities, presence of treatments and previous hospitalization. Patient survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Negative binomial "Generalized Estimated Equation" Fish models were used to assess differences in healthcare consumption. Associated costs were calculated in €2022 according to the French Health Insurance perspective, and were studied using a repeated measures regression model for each year of follow-up.

RESULTS: 1,058 patients were included between 2017 and 2020. Among them, 69% were men, with an average age of 73.6±12.3 years. Kaplan-Meier estimation showed that mean survival time was 40.3 months for TM patients, and 39.5 months for non-TM patients (p=0.18). A sub-analysis of patients included after 2020 showed a mean survival time of 28.1 months for TM patients versus 26.9 months for non-TM patients (p=0.0023). During the first post-inclusion year, the average monthly cost for TM patients was €1,345.5 versus €1,141.0 for non-TM patients, i.e. a 15% lower average monthly cost (RR=0.85; IC95% [0.79 ;0.91]) for non-TM patients (p<0.0001). The proportion of patients with at least one emergency room visit was significantly lower in TM patients (RR=1.27, IC95% [1.08; 1.49], p=0.0043).

CONCLUSIONS: The results showed that TM patients had better survival and higher costs than non-TM patients.