Remote Patient Management Facilitates Guideline Directed Medical Therapy Improving Outcomes.

Abstract

<h3>Introduction</h3> Prior Remote Patient Management (RPM) studies in Heart Failure (HF) yielded mixed results. These trials did not achieve sufficient patient and/or clinician compliance, used different monitoring tools, and failed to integrate RPM into daily workflow. GDMT is the most evidenced based strategy for HF management. However, episodic office visits (OV) do not adequately achieve optimization of therapy. Real-time, data-based, therapeutic adjustments using RPM drives better outcomes through improved HF management. A patient-centric RPM approach improves compliance, decreases OV, and reduces hospitalizations. Ultimately, this should lead to less morbidity and increased longevity. Establishing workflows that incorporate GDMT enabled by RPM is essential for providers to achieve next generation HF care. <h3>Hypothesis</h3> RPM will reduce HF hospitalizations and Emergency Department (ED)/Hospital Outpatient IV diuretic visits. <h3>Methods</h3> We retrospectively studied the 2-year experience of 40 subjects with New York Heart Association Class II or Class III HF regardless of EF. All patients utilized the Cordella Heart Failure System to transmit daily weight, blood pressure, heart rate, and pulse-ox data, as well as symptoms via wireless tablet. The cardiologist and nursing staff established workflow patterns to facilitate daily monitoring. GDMT optimization recommendations and lifestyle adjustments were communicated to patients via telephone and tablet-based messaging. <h3>Results</h3> Patient compliance (data sent 5 of 7 days) was >90% (after patient training) and increased to 95% 2 years later. Clinician compliance (checking data at least twice weekly) was 100%. HF hospitalizations and ED/Hospital Outpatient IV diuretic visits were reduced as shown in Table 2. Volume of phone calls leading to medication changes increased 6-fold with RPM while OV decreased by 14.5%. HF hospitalizations decreased by nearly 85%. <h3>Conclusion</h3> New workflow patterns allowed this practice to use RPM to facilitate real-time GDMT optimization and lifestyle changes that achieved reduced HF Hospitalizations, OV, and HF ED/Hospital Outpatient IV diuretic visits with excellent patient compliance.