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

Published:January 29, 2008DOI:https://doi.org/10.1016/j.ijcard.2007.10.027

      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).

      Conclusions

      This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ashton C.M.
        • Kuykendall D.H.
        • Johnson M.L.
        • et al.
        The association between quality of inpatient care and early readmission.
        Ann Intern Med. 1995; 122: 415-421
        • Vinson J.M.
        • Rich M.W.
        • Sperry J.C.
        • et al.
        Early readmission of elderly participants with congestive heart failure.
        J Am Geriatr Soc. 1990; 38: 1290-1295
        • Harjaj K.J.
        • Thompson H.W.
        • Turgut T.
        • et al.
        Simple clinical variables are markers of the propensity for early readmission in heart failure patients.
        J Cardiac Failure. 1999; 5: 80
        • Di Lenarda A.
        • Scherillo M.
        • Maggioni A.P.
        • Acquarone N.
        • Ambrosio G.B.
        • et al.
        Current presentation and management of heart failure in cardiology and internal medicine hospital units: a tale of two worlds—the Temistocle study.
        Am Heart J. 2003; 146: E12
        • Rich M.W.
        • Beckham V.
        • Wittemburg C.
        • et al.
        A multidisciplinary intervention to prevent the readmission of elderly participants with congestive heart failure.
        N Engl J Med. 1995; 333: 1190
        • Hanumanthu S.
        • Butler J.
        • Chomsky D.
        • et al.
        Effect of a heart failure program on hospitalization frequency and exercise tolerance.
        Circulation. 1997; 96: 2842-2848
        • Stewart S.
        • Horowitz J.D.
        Home-based Intervention in Congestive Heart Failure. Long-Term Implications on Readmission and survival.
        Circulation. 2002; 105: 2861-2866
        • Jaarsma T.
        • Halfens R.
        • Huijer Abu-Saad H.
        • et al.
        Effects of education and support on self-care and resource utilization in patients with heart failure.
        Eur Heart J. 1999; 20: 673-682
        • Weinberger M.
        • Oddone E.Z.
        • Henderson W.G.
        Does increased access to primary care reduce hospital readmissions?.
        N Engl J Med. 1996; 334: 144-1447
        • Senni M.
        • Gavazzi A.
        How patients with heart failure are managed in Italy.
        Eur J Heart Failure. 2001; 3: 257-260
        • Scalvini S.
        • Glisenti F.
        Centenary of tele-electrocardiography and telephonocardiography — where are we today?.
        Journal of Telemedicine and Telecare. 2005; 11: 325-330
        • Scalvini S.
        • Zanelli E.
        • Gritti M.
        • Pollina R.
        • Giordano A.
        • Glisenti F.
        Appropriatezza diagnostica dell'invio in pronto soccorso mediante un servizio di telecardiologia.
        Ital Heart J Suppl. 2000; 1: 905-909
        • Louis A.A.
        • Turner T.
        • Gretton M.
        • Baksh A.
        • Cleland J.G.F.
        A systematic review of telemonitoring for the management of heart failure.
        The European Journal of Heart Failure. 2003; 5: 583-590
        • McAlister F.A.
        • Stewart S.
        • Ferrua S.
        • Mc Murray J.J.
        Multidisciplinary strategies for the management of heart failure patients at high risk for admission.
        J Am Coll Cardiol. 2004; 44: 810-819
        • Kimmelstiel C.
        • Levine D.
        • Perry K.
        • Patel A.R.
        • Sadaniantz A.
        • Gorham N.
        • Cunnie M.
        • Dunggan L.
        • Cotter L.
        • Shea-Albright P.
        • 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: 1450-1455
        • Cleland J.G.F.
        • Louis A.A.
        • Rigby S.A.
        • Janssens U.
        • Balk A.H.M.M.
        Noninvasive Home Telemonitoring for Patients with Heart Failure at High Risk of Recurrent Admission and Death.
        J Am Coll Cardiol. 2005; 45: 1654-1664
        • Scalvini S.
        • Zanelli E.
        • Volterrani M.
        • et al.
        A pilot study of nurse-led, home-based telecardiology for patients with chronic heart failure.
        J Telemedecine and Telecare. 2004; 10: 113-117
        • Schulman K.A.
        • Mark D.B.
        • Califf R.M.
        Outcomes and costs within a disease management program for advanced congestive heart failure.
        Am Heart J. 1998; 135: S285-S292
        • Altman D.G.
        • Andersen K.
        Calculating the number needed to treat for trials where the outcome is time to an event.
        BMJ. 1999; 319: 1492-1495
        • McMurray J.J.
        • Stewart S.
        Epidemiology, aetiology and prognosis of heart failure.
        Heart. 2000; 83: 596-602
        • Krumholz H.M.
        • Parent E.M.
        • Tu N.
        • et al.
        Readmission after hospitalisation for congestive heart failure among Medicare beneficiaries.
        Arch Intern Med. 1997; 157: 99-104
        • Erhardt L.
        • Cline C.
        Heart failure clinics: a possible means of improving care.
        Heart. 1998; 80: 428-429
        • Roccaforte R.
        • Demers C.
        • Baldassarre F.
        • Koon T.
        • Yusuf S.
        Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis.
        Eur J Heart Fail. 2005; 7: 1133-1144
        • Phillips C.
        • Wright S.
        • Kern D.
        • Singa R.
        • Shepperd S.
        • Rubinacker M.
        Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis.
        JAMA. 2004; 291: 1358-1367
        • Gonseth J.
        • Guallar-Castillon P.
        • Banegas J.
        • Rodriguez-Artalejo F.
        The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports.
        Eur Heart J. 2004; 25: 1570-1595
        • Goldberg L.R.
        • Piette J.D.
        • Walsh M.N.
        • 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.
        Am Heart J. 2003; 146: 705-712
        • Bondmass M.
        • Benatar J.D.
        • Castro G.
        • Avitall B.
        A prospective randomized study comparing outcomes and outpatient care delivery methods for chronic heart failure.
        J Am Coll of Cardiol. 2001; 37: 1A-648A
        • Jerant A.F.
        • Azari R.
        • Nesbitt T.S.
        Reducing the costs of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention.
        Med Care. 2001; 39: 1234-1245
        • Massie B.M.
        • West J.
        • Van Ostaeyen D.
        • Salbalvaro A.
        A controlled trial of heart failure management programs.
        J Am Coll Cardiol. 2001; 37: 1A-648A
        • Heidenreich P.A.
        • Ruggerio C.M.
        • Massie B.M.
        Effect of a home monitoring system on hospitalization and resource use for patients with heart failure.
        Am Heart J. 1999; 138: 633-640
        • Johnson B.
        • Wheeler L.
        • Deuser J.
        • Sousa K.H.
        Outcomes of the Kaiser Permanente Tele-Home Health Research Project.
        Arch Fam Med. 2000; 9: 40-45
        • Kesinger T.
        • Gilani S.
        • Jennison S.H.
        Electronic home monitoring reduces hospital admission, length of stay and readmission frequency in a selected heart failure population.
        J Card Fail. 2002; 8: S94
        • Wootton R.
        Telemedicine: clinical review.
        BMJ. 2001; 323: 557-560