Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure

Giordano, A.; Scalvini, S.; Zanelli, E.; Corrà, U.; G.L., Longobardi; Ricci, V.A.; Baiardi, P.; Glisenti, F.

doi:10.1016/j.ijcard.2007.10.027

« Previous Next »International Journal of Cardiology
Volume 131, Issue 2 , Pages 192-199, 9 January 2009

Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure

A. Giordano
- Cardiology Departments Fondazione “Salvatore Maugeri”, I.R.C.C.S.: Gussago (BS), Italy
S. Scalvini
- Cardiology Departments Fondazione “Salvatore Maugeri”, I.R.C.C.S.: Gussago (BS), Italy
- Corresponding author. Department of Cardiology, “Salvatore Maugeri” Foundation, Istituto di Ricovero e Cura a Carattere Scientifico, Via Pinidolo 23, 25124 Gussago, Brescia, Italy. Tel.: +39 0 2521264; fax: +39 0 2528344.
E. Zanelli
- Cardiology Departments Fondazione “Salvatore Maugeri”, I.R.C.C.S.: Gussago (BS), Italy
U. Corrà
- Veruno (NO), Italy
G.L. Longobardi
- Cassano Murge (BA), Italy
V.A. Ricci
- Telese (CE), Italy
P. Baiardi
- Biostatistical Unit, Pavia, Italy
F. Glisenti
- CO.ME.TE. Consorzio per la Ricerca, Sviluppo e Sperimentazione di Sistemi di Telemedicina (MI), Italy

Received 25 July 2006; received in revised form 14 April 2007; accepted 26 October 2007. published online 29 January 2008.

Abstract

Background

Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for improving clinical outcomes. However, the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown.

The aim of the study was to determine whether a home-based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow-up programme over a one-year period.

Methods and results

Four hundred-sixty CHF patients (pts), aged 57±10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one-year hospital readmission for cardiovascular reasons. During one-year follow-up 55 pts (24%) in HBT group and 83 pts (36%) in UC group had at least one readmission (RR=0.56; 95% CI: 0.38–0.82; p=0.01). After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR=0.50, 95% CI: 0.34–0.73; p=0.01). The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group).

The rate of hearth failure-related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR=0.49, 95% [CI]: 0.31–0.76; p=0.0001). No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was significantly lower in HBT group (€ 843+/−1733) than in UC group (€ 1298+/−2322), (−35%, p<0.01).