"My name is Stefan Stoerk from Wuerzburg, Germany. I've been working in Cardiovascular Medicine for 25 years. I'm affiliated to the University of Wuerzburg and today I'm discussing with you the main findings of a secondary analysis of the TIM HF2 trial.

The reason why we undertook this analysis was that it has been well acknowledged for some time that there is a rural urban divide with regards to the burden of heart failure. So that means that there is a higher prevalence and incidence in rural areas. Whereas the reasons behind this are, not entirely clear. It's very important to address this problem and in this context remote patient management may have a role and we decided to investigate this.

We made use of the data set of the TIM HF2 trial, which was a large telemedical trial conducted in Germany. The main results have been published in 2018 and you have to have a little bit of a background to understand, how we proceeded with the secondary analysis.

So TIM HF study was a trial which was open label and used in the control arm care as usual and in the intervention arm. Patients that had experienced an episode of heart failure decompensation were supported with a remote patient management program that was conducted through a telemedical center. So there was a centralized telemedical structure which took care for the patients in a remote fashion. All the patients received, external variables and patient related outcome tablets. So they recorded their own, behavior and their feelings and they were cared for by dedicated physicians and allied health professionals from the telemedical center. So there was a 12 month period of ongoing, monitoring and education by the telemedical staff.

The remote patient management program of the TIM HF 2 trial consisted of, a fully fledged telemedical center that was staffed with dedicated heart failure physicians and nurses. They care for patients telematically, by handing out external devices to the patients and monitoring the incoming information on a daily and 247 basis. And if certain corridors were crossed, certain actions were taken, days alive and out of hospital were reduced. Remarkably it's in the order of seven days per a, 12 month period. So all cause death was significantly reduced and there was a trend for a lower cardiovascular mortality.

So the described analysis looked into the research question whether there is a rural urban divide also in TIM HF 2. That means which key factors might influence the effectiveness the remote patient management program might have in rural and in urban areas. To study this we looked at three key factors. One was the location of the cardiologist rural versus urban. The other was the patient's place of residence. And the third one was the travel distance between the two locations, the patient's place of residence and the responsible cardiologist.

We found that the remote patient management program worked equally well both in rural and in urban areas. But we also found that the program exerted greater benefits the farther the patient lived away from the cardiologist. To illustrate this, we found that for every doubling of the distance, the risk reduction increased by 13%. This is quite a large effect associated with this travel distance.

The main finding of this study is that remote patient management is effective for any chronic heart failure patient, but it works even better if you live farther away from a special health care service. So this is important information for health, policymakers. For example, in Germany, we currently are in the rollout phase of telemedical care. And now with this information, we can prioritize, this rollout to those who need it best.

It would be very interesting to find out whether the new metric we define the travel distance between the patient's place of residence and the healthcare service, also can be replicated in other studies. So there are many telemedical studies, and it would be very nice to investigate whether this observation also holds in other studies.”