Telemonitoring of heart failure patients by a nationally licensed nurse

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The protocol of cooperation between health professionals entitled "remote monitoring, titration consultation and unscheduled consultation, with or without telemedicine, of patients treated for heart failure, by a nurse" annexed to the order, is authorized on national territory in conditions provided for by the health law of July 24, 2019. This reformed the system governing the protocols for interprofessional cooperation.

"As a temporary measure and until the launch of a dedicated online application, the employment or exercise structure is required to declare to the regional health agency (ARS) health professionals who 'mutually commit to applying the cooperation protocol by digital sending "of a set of supporting documents, specifies the order.

This protocol was the subject of an opinion from the college of the High Health Authority (HAS) dated November 20. The college ruled on a request sent by the director general of the ARS Ile-com-France for a protocol promoted by the cardiology department of the Henri-Mondor hospital in Créteil (AP-HP).

It consists of delegating a cardiologist to a state-certified nurse (IDE):

• carrying out follow-up consultations for heart failure, for the titration of systolic heart failure medicines in face-to-face or for heart decompensation, in-person or in teleconsultation

• remote monitoring

• patient orientation.

The nurse can contact a delegating doctor at any time, in the event of an alert or emergency.

This protocol aims to allow early management and close monitoring of heart failure, to quickly optimize medical treatment which stabilizes the disease, slows its course and reduces morbidity and mortality (cardiac decompensations, hospitalizations, deaths). It must promote ambulatory medicine.

A decision tree is provided for the interpretation of the electrocardiogram (ECG) as well as decision trees during a face-to-face consultation or during a telephone evaluation.

The HAS considered that the description of the cooperation protocol is likely to guarantee the quality and safety of patient care.

The derogatory economic model, defined on the basis of a study carried out in Ile-com-France, provides for technical procedures, a consultation at 25 euros and a fixed rate of 200 euros per year and per patient for the follow-up of patients with 'a chronic pathology.

Nurses receive specific training, the details of which are also provided in the appendix.

(Official Journal, Tuesday, December 31, 2019, text 96)

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