Home Telemonitoring of Community-Dwelling Heart Failure Patients After Home Care Discharge.

Background: Home telemonitoring (HTM) is a promising approach to improve quality of life (QoL) and decrease hospital utilization. Methods: This randomized-controlled study followed 89 community-dwelling Medicare outpatients with heart failure (HF) after discharge from home care for 6 months. Patients were randomized to HTM or comprehensive outpatient management (COM). HTM received weekly (video) televisits with daily vital sign monitoring. COM was contacted weekly by telephone. Outcomes included emergency department (ED) and inpatient utilization and QoL. Results : Average age at enrollment was 81.4 for HTM and 84.9 for COM. Thirty-eight percent of HTM had ≥1 ED visit versus 60% of COM (p = 0.04), while 48% of HTM had ≥1 hospitalization versus 55% of COM (p = 0.47). Length of stay (LOS) (days) was 4.0 for HTM versus 7.4 for COM (p = 0.39). Costs were $38,990 for HTM versus $50,943 for COM (p = 0.91). QoL improved by -9.66 for HTM and -3.56 for COM (p = 0.02). Although HF-related utilization did not differ between groups, HTM patients who were highly adherent obtained better all-cause outcomes than those with low adherence. Conclusions: Significantly improved all-cause ED utilization, LOS, and QoL were found for HTM; other differences were not significant. More research is needed to determine how to best utilize this technology to improve patient outcomes.

A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure.

Background:Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days.Methods:This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate.Results:Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83-2.27), hospitalization (RR = 0.92, CI = 0.57-1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50-28%; COM = 57-13%; p = 0.05).Conclusions:These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.