Heart failure case disease management program: a pilot study of home telemonitoring versus usual care

Abstract

Background Telemonitoring care can be integrated into health care provision as a substitute for routine clinical follow-up. A telemonitoring service (TMS) integrated into the process of chronic heart failure (CHF) care has not so far been evaluated. Objectives We describe our comprehensive home TMS and evaluate its outcomes in comparison to the usual program of care after discharge from a Heart Failure Unit (HFU). Methods 133 patients discharged from a HFU, underwent risk cluster classification for cardiac events and were prospectively randomized to usual community care ( n =66) and to a management program delivered by the TMS ( n =67). Clinical outcome including re-hospitalization, cardiac death, and emergency room access, was compared in the two groups. Results Patients were clustered as at low ( n =51), moderate ( n =43) and high ( n =39) risk. The compliance to telemonitoring was 82%. The compliance to system follow-up was (81%). The mean individual access rate to the TMS was 4.6±3.3 calls. Active interventions were made following 54% of the accesses. After 10±6 months, 135 events had occurred: 103 in the usual care group and 32 in telemonitoring group ( P <0.001). Re-hospitalisation was 22 (TMS) vs 77 (usual care) ( P <0.009). Cluster risk classification intercepted patients' increased health care demands (low risk: 0.34±0.62; moderate risk 1±1.2; high risk 1.9±1.5 events) Conclusion A management program delivered by a TMS can reduce health care demands by CHF patients.