Patient-centred home-based management of heart failure. Findings from a randomised clinical trial evaluating a tablet computer for self-care, quality of life and effects on knowledge.

ABSTRACT

OBJECTIVES: To evaluate whether a new home intervention system (HIS, OPTILOGG(®)) consisting of a specialised software, a tablet computer (tablet) wirelessly connected to a weight scale may improve self-care behaviour, health-related quality of life (HRQoL), knowledge about heart failure (HF) and reduce hospital days due to HF. DESIGN: 82 patients (32% females) with mean age 75 ± 8 years hospitalised with HF were randomised at discharge to an intervention group (IG) equipped with the HIS or to a control group (CG) receiving standard HF information only. The tablet contained information about HF and lifestyle advice according to current guidelines. It also showed present dose of diuretic, changes in patient-measured weight and HRQoL over time. RESULTS: After 3 months the IG displayed a dramatic improvement in self-care with p < 0.05 (median IG 17 [IQR 13, 22] and CG 21 [IQR 17, 25]). The disease-specific HRQoL was measured by Kansas City Cardiomyopathy Questionnaire. The IG had significantly higher score (median IG 65.1 [IQR 38.5, 83.3] vs. CG 52.1 [IQR 41.1, 64.1] p < 0.05) and an improved physical limitation (median IG 54.2 [IQR 37.7, 83.3] vs. CG 45.8 [IQR 25.0, 54.2] p < 0.05) There was no difference in knowledge. IG showed fewer HF-related days in the hospital, with 1.3 HF-related hospital days/patient versus 3.5 in CG (risk ratio 0.38; 95% confidence interval 0.31-0.46; p < 0.05). CONCLUSION: HF patients with a HIS tablet computer and scale improved in self-care and HRQoL. Days in hospital due to HF were reduced. A medical device that is easy to use can be a valuable tool for improving self-care and outcome in patients with HF.