- Telemonitoring for heart failure patients has been shown to reduce mortality rates by up to 36% and decrease hospitalization rates in studies such as TEN-HMS and the Cochrane review. - The Hull model of telemonitoring in the UK involves a comprehensive system of care including home monitoring devices, community kiosks, and support from nurses and specialist clinics to closely manage heart failure patients. - Further research and investment in telemonitoring technologies could help shift care from crisis management to proactive health maintenance and empowering patients to better self-manage their condition.

1. Telemonitoring for Heart Failure Evidence & Practice Professor John G.F. Cleland Department of Cardiology, Hull Y o rk Medical School University of Hull Kingston-upon-Hull UK Conflict of Interest: I have received honoraria and/or research support from Philips, Bosch, GE, Alere and St Jude

6. TeleHealth - What Might it Achieve? Ultimate Intermediate

7. TEN-HMS The Trans-European Network–Home-Care Management System Patients about to be discharged from hospital after an exacerbation of chronic heart failure (Published JACC 2005) 54% of Patients Aged >70 years

8. p < 0,05 Mortality Cleland et al JACC 2005 TEN-HMS Reduction in Mortality NTS or HTM v UC Absolute 16.4% Relative 36 % No reduction in hospitalisation Shortening of hospital stay with HTM

9. TEN-HMS much safer safer no change more anxious much more anxious “ How do you feel about your health since receiving Telemonitoring? “ Undef.

10. TEN-HMS 120 Days 240 Days % *** *** *** *** differences between HTM and other groups. No difference between UC and NTS Achieving Therapeutic Target 240 Days Patient Clinical Status

11. TEN-HMS: Total Patient Contacts Contacts Per 1,000 Days Alive and Out of Hospital # # under-reporting of events likely in this group P<0.01 HTM v NTS

15. Percent of Days Lost To Hospitalisation or Death 8.9% 8.4% 37.0% 21.3% 22.6% TEN-HMS (15 months) TIM-HF (26 months) TEHAF (12 months) 4.5% 6.1%

18. Services for Patients with Heart Failure The Kingston-upon-Hull Model Heart Failure Discharge Nurse Heart Failure Telemonitoring Nurse Community Heart Failure Specialist Nurses Patients in Hospital Patients at Home Voluntary Patient-Support Organisations Specialist Clinics Family Doctor (NT-proBNP)

19. Cost-Effectiveness of TeleHealth (Hull)

21. The Hull Heart Failure Life-Lab 30,000 patient-years of follow-up Largest, Longest Follow-up, Epidemiologically-Representative Cohort of Heart Failure in the World Rich in phenotyping, serial biomarker and outcome data

23. Patient / Carer Communication System ‘ Monitor’ Analysis Health-Care Provider Secondary Loop Primary Loop 70% of Care Decisions Motivation: feedback on measures and trends, what they mean and what to do about them Education: on healthy lifestyle, reasons for treatments, self management Intelligent, integrated, multi-measure (time & type) personalised analysis