Quality of Life Among Patients with Heart Failure with Reduced Ejection Fraction Receiving Telemedicine Care in Vietnam.

Abstract

Background: Telemedicine is an effective method to monitor patients at home and improve outcomes of heart failure (HF), especially HF with reduced ejection fraction (HFrEF). However, little is known about the impact of telemedicine on the quality of life (QoL) among outpatients with HFrEF in lower-middle-income countries (LMICs). Methods: In this single-center, prospective, randomized, controlled, open, and parallel-group clinical trial in northern Vietnam, patients with HFrEF were allocated to either telemedicine or control groups. Participants in the experimental arm underwent a home-based telemedicine program with regular telephone follow-ups and consultations. Participants in the control group received usual care. Both groups were followed for 6 months. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline. The analysis was conducted on an intention-to-treat basis. Results: A total of 223 participants were randomized into two groups-the telemedicine group and the usual care group. Of the 223, 170 patients [mean age: 61.5 ± 15.0 years; female: 122 (71.8%)] completed follow-up and were included in the final analysis (87 in the telemedicine group and 83 in the usual care group). At baseline, the MLHFQ scores were equivalent between the two groups (median [interquartile range]: 81 [73-92] vs. 81 [74-92]; p = 0.992). After 6-month follow-up, the telemedicine group showed greater improvement in MLHFQ total scores than the usual care group (mean change in MLHFQ score: -15.5 ± 14.0 vs. -1.3 ± 6.2; difference in change: -14.2 [95% confidence interval, CI: -17.5, -11.0]; p < 0.0001). Similar results were found for the MLHFQ physical dimension score (difference in change: -5.8 [95% CI: -7.4, -4.1]; p < 0.0001) and the MLHFQ emotional dimension score (difference in change: -3.2 [95% CI: -4.2, -2.2]; p < 0.0001). Conclusions: In this study, a telemedicine intervention significantly improved QoL compared with usual care among patients with HFrEF in an LMIC.