Use of remote monitoring to improve outcomes in patients with heart failure: a pilot trial

Ambar Kulshreshtha, Joseph C Kvedar, Abhinav Goyal, Elkan F Halpern, Alice J Watson, Ambar Kulshreshtha, Joseph C Kvedar, Abhinav Goyal, Elkan F Halpern, Alice J Watson

Abstract

Remote monitoring (RM) of homebound heart failure (HF) patients has previously been shown to reduce hospital admissions. We conducted a pilot trial of ambulatory, non-homebound patients recently hospitalized for HF to determine whether RM could be successfully implemented in the ambulatory setting. Eligible patients from Massachusetts General Hospital (n = 150) were randomized to a control group (n = 68) or to a group that was offered RM (n = 82). The participants transmitted vital signs data to a nurse who coordinated care with the physician over the course of the 6-month study. Participants in the RM program had a lower all-cause per person readmission rate (mean = 0.64, SD +/- 0.87) compared to the usual care group (mean = 0.73, SD +/- 1.51; P-value = .75) although the difference was not statistically significant. HF-related readmission rate was similarly reduced in participants. This pilot study demonstrates that RM can be successfully implemented in non-homebound HF patients and may reduce readmission rates.

Figures

Figure 1
Figure 1
Study flow diagram. RM: Remote Monitoring; HF: Heart Failure; ER: Emergency Room visits.

References

    1. Kannel WB. Incidence and epidemiology of heart failure. Heart Failure Reviews. 2000;5(2):167–173.
    1. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):480–486.
    1. Wolinsky FD, Overhage JM, Stump TE, Lubitz RM, Smith DM. The risk of hospitalization for congestive heart failure among older adults. Medical Care. 1997;35(10):1031–1043.
    1. Massie BM, Shah NB. Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. American Heart Journal. 1997;133(6):703–712.
    1. Holland R, Battersby J, Harvey I, Lenaghan E, Smith J, Hay L. Systematic review of multidisciplinary interventions in heart failure. Heart. 2005;91(7):899–906.
    1. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. Journal of the American College of Cardiology. 2004;44(4):810–819.
    1. Galbreath AD, Krasuski RA, Smith B, et al. Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation. 2004;110(23):3518–3526.
    1. Artinian NT, Harden JK, Kronenberg MW, et al. Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure. Heart and Lung. 2003;32(4):226–233.
    1. Jovicic A, Holroyd-Leduc JM, Straus SE. Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovascular Disorders. 2006;6, article 43
    1. Clark RA, Inglis SC, McAlister FA, Cleland JGF, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. British Medical Journal. 2007;334(7600):942–945.
    1. Klersy C, De Silvestri A, Gabutti G, Regoli F, Auricchio A. A meta-analysis of remote monitoring of heart failure patients. Journal of the American College of Cardiology. 2009;54(18):1683–1694.
    1. Roccaforte R, Demers C, Baldassarre F, Teo KK, Yusuf S. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. European Journal of Heart Failure. 2005;7(7):1133–1144.
    1. Myers GRS, Lugn NE, Holbert B, Kvedar JC. Impact of home-based monitoring on the care of patients with congestive heart failure. Home Health Care Management and Practice. 2006;18(6):444–451.
    1. N. E. H. Institute. Remote Physiological Monitoring. Vol. 2009. University of Cambridge; 2008.
    1. Spaeder J, Najjar SS, Gerstenblith G, et al. Rapid titration of carvedilol in patients with congestive heart failure: a randomized trial of automated telemedicine versus frequent outpatient clinic visits. American Heart Journal. 2006;151(4):844.e1–844.e10.
    1. Chaudhry SI, Wang Y, Concato J, Gill TM, Krumholz HM. Patterns of weight change preceding hospitalization for heart failure. Circulation. 2007;116(14):1549–1554.
    1. Bakken S, Grullon-Figueroa L, Izquierdo R, et al. Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. Journal of the American Medical Informatics Association. 2006;13(6):660–667.
    1. Demiris G, Speedie S, Finkelstein S. A questionnaire for the assessment of patients’ impressions of the risks and benefits of home telecare. Journal of Telemedicine and Telecare. 2000;6(5):278–284.
    1. Social Security Death Index. vol. 2009.
    1. Chaudhry SI, Barton B, Mattera J, Spertus J, Krumholz HM. Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. Journal of Cardiac Failure. 2007;13(9):709–714.
    1. Chumbler NR, Neugaard B, Ryan P, Qin H, Joo Y. An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring. Journal of Telemedicine and Telecare. 2005;11(3):150–156.
    1. Medicare. Medicare Benefit Policy Manual. 2008;2009
    1. Chaudhry SI, Phillips CO, Stewart SS, et al. Telemonitoring for patients with chronic heart failure: a systematic review. Journal of Cardiac Failure. 2007;13(1):56–62.
    1. Goldberg LR, Piette JD, Walsh MN, et al. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. American Heart Journal. 2003;146(4):705–712.
    1. Benatar D, Bondmass M, Ghitelman J, Avitall B. Outcomes of chronic heart failure. Archives of Internal Medicine. 2003;163(3):347–352.
    1. Cleland JG, Louis AA, Rigby AS, Janssens U, Balk AH. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. Journal of the American College of Cardiology. 2005;45(10):1654–1664.
    1. Seibert PS, Whitmore TA, Patterson C, et al. Telemedicine facilitates CHF home health care for those with systolic dysfunction. International Journal of Telemedicine and Applications. 2008;2008:7 pages. Article ID 235031.
    1. Kimmelstiel C, Levine D, Perry K, et al. Randomized, controlled evaluation of short- and long-term benefits of heart failure disease management within a diverse provider network: the SPAN-CHF trial. Circulation. 2004;110(11):1450–1455.
    1. Kashem A, Droogan MT, Santamore WP, Wald JW, Bove AA. Managing heart failure care using an internet-based telemedicine system. Journal of Cardiac Failure. 2008;14(2):121–126.
    1. Scalvini S, Zanelli E, Volterrani M, et al. A pilot study of nurse-led, home-based telecardiology for patients with chronic heart failure. Journal of Telemedicine and Telecare. 2004;10(2):113–117.
    1. Morguet AJ, Kühnelt P, Kallel A, Jaster M, Schultheiss H-P. Impact of telemedical care and monitoring on morbidity in mild to moderate chronic heart failure. Cardiology. 2008;111(2):134–139.
    1. Schofield RS, Kline SE, Schmalfuss CM, et al. Early outcomes of a care coordination-enhanced telehome care program for elderly veterans with chronic heart failure. Telemedicine Journal and e-Health. 2005;11(1):20–27.

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