Chronic heart Failure Essay Example

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2Chronic Heart Failure


By (Name of Student)

Randomised Controlled Trial (RCT) is a type of experimental or interventional study design. Participants whom can either be individuals or groups are allocated randomly to receive either a controlled treatment or the new intervention that is being tested (either a placebo or the standard treatment). Each and every step of the study is well followed up and the severity or amount of the disease is measured in the intervention group, the results are then compared with the controlled group.

This study is based on analysis of two studies performed by Koechler et al (2011) and McKinstry et al (2013). Both studies were made on telemonitoring or telemedical management and analysis of patients with possible heart failure problems. The management was done remotely in both studies and on a specific randomised target group. Therefore, the trial addressed clearly focused issue. Secondly, the assignment of patients were randomized, in reference to Koehler et al, 170 patients who had chronic HF participated where 50% were randomly assigned to telemedical management analysis and 50% were taken through usual care. McKinstry et al (2013) indicates that participants were randomly selected using a secure computer system in order to protect biasness where the intervention was 50% randomization and 50% to usual care. Moreover, the participants’ selection in both studies was done in averagely one and a half years.

Results at the end of the study indicated that not all participants made it through the study period. Koehler et al (2011) indicated 81% reliability in the study since some participants did not participate during HF hospitalizations while others suffered cardiovascular deaths. McKinstry et al (2013) indicates that data for 90% of the participants was availed and analysed while the other 10% of the participants dropped out of the study hence no conclusive and reliable data could be obtained from them.

Patients especially in McKinstry et al study indicate that some of them discontinued their participation due to privacy and uncomfortableness in the study participation. On the other hand, medical practitioners like the practice nurse consultation lacked confidence during the early stages of the study but gained confidence as the process continued. Koehler et al (2011) did not elaborate much on the participants’ perception on the treatment.

Sample groups were same at the start of the trial by the fact that all participants in both studies were adults (over 18 years). The only slight difference is that Koehler et al (2011) indicated that its participants were of 18 years and above while McKinstry et al (2013 indicated that its participants were over 18 “yes” but above 25 years. Sex of the participants was not profound in both studies. Therefore it is safe to state that the researcher did not perceive gender as of influence to the study outcome.

The groups in the two studies were treated differently. In reference to Koehler et al (2011) the patient performed their daily self-assessment same as patients in McKinstry et al study but patient information in Koehler et al was transferred in a more secure manner since it was dynamically encrypted. Patients received feedback on their medical status via text message or email (McKinstry et al 2013).

Outcome measured was mainly the blood pressure levels that was usually done by analysing data collected during daytime ambulatory blood pressure monitoring. The study analysed the two categories of participants (randomized and usual care) in order to know how different patients react to cardiovascular medication while confined to either telemonitored or usual care.

Primary outcome of both studies is clear. This can be justified by the fact that, it clearly indicates that 0.3% more of the cause of deaths from heart failure or attack occur in usual care groups as opposed to remote telemonitoring. More deaths caused as a result of heart failures can be prevented if only more patients are subjected to telemonitoring.

Primary outcome indicates that the mean of “daytime systolic ambulatory blood pressure” reduced in both telemonitored and usual care patients. The same results were noted in the secondary outcome as well although the secondary outcome went further to state that the usual groups and intervention did not significantly differ in its outcome (Koehler et al 2011).

Confidentiality of the patients’ medical status and wellbeing were not very much considered in the method used in the two studies. This can be echoed by the fact that patients were advised to transfer their personal information through the internet for example via email and through text messages. This can expose the medical conditions of patients to be vulnerable to accessibility by unauthorized persons and in return course damages to ones being. Secondly, the issue on patients communicating their status with unseen or unknown persons led to some participants’ withdrawal from the study. Furthermore, it is indicated from the study that medical practitioners like nurses lacked enough confidence while interacting with patients, this factor can easily lead to lack of openness in the patient (Koehler 2011).

Living in a multicultural diverse society and with the present technological error, the study results can be applicable or not applicable depending on the community that one is applying them to. In regards to a population that is culturally diverse and appreciates education and technological advancement, the results will be applicable for the fact that they well understand that Information sharing is vital and can be achieved by a click of a button. The public will prefer sharing with medical practitioners such issues as long as they are guaranteed of confidentiality and rapid response to their medical needs. On the other hand, the results might be inapplicable to the population that has strong traditional cultures and beliefs since some believe that these sort of issues (medical) ought to be kept in secret and dealt with in total confidentiality.

The studies lack information that can change the conclusion dynamics, such information include; effect of the exercise on the youth especially the youth under 18 years of age. Due to the energetic full of life lifestyle of the youth could there be any deference in the way the two groups (telemonitored and usual cared) responded to the exercise. What if gender parity issue was considered at high level? Could there be any similarities and differences to the way the male and female would respond to the practice? If these issue were taken into consideration, it could have brought about same different conclusion to the study.

The benefits of the study are worth the cost. In reference to the study, it can be concluded that majority of the participants found it easier to convenient to share their medical dilemmas which otherwise could have been difficult in situations that the patient had to visit a medical facility for the same. The study justifies that patients were trained on how to access and use digital devices at their convenience in self-assessing their blood pressure levels, share with the medical practitioners, receive advisory services on the same and at their convenient place and time. The study also enabled medical practitioners to gather more intimate information from patients or participants by the fact that they got used to the process over time.


McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMj, 346, p.f3030.

Koehler, F., Winkler, S., Schieber, M., Sechtem, U., Stangl, K., Böhm, M., Boll, H., Baumann, G., Honold, M., Koehler, K. and Gelbrich, G., 2011. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure. Circulation, pp.CIRCULATIONAHA-111.