Telemonitoring patients with chronic heart failure. Results from a pilot study in the Veneto Region, Italy

Abstract

Remote monitoring of patients with chronic heart failure (HF) can prevent acute episodes of HF, optimize treatment, reduce emergency room (ER) visits and hospitalizations, and improve quality of life of patients and caregivers. In current clinical practice, however, the most appropriate model is still under debate. We aimed to evaluate the impact of a new remote telemonitoring (TM) system in the clinical management of HF patients on the reduction of hospitalizations and ER admissions and on possible related-economic benefits. A working group participated by primary care and family practitioners, cardiologists, home care nurses of the 8th Local Health Unit of the Veneto Region, Italy, has established a new operating procedure for TM chronic HF patients, identifying the clinical profiles and the inclusion/exclusion criteria of enrollment, the clinical parameters to be monitored, the input/output modalities of the information to/from the call center, the alarm criteria and the response procedures. Patients were profiled into three risk categories based on age, clinical characteristics, prognosis assessment, and social needs and provided with appropriate devices for remote measurement and transmission of blood pressure, heart rate, peripheral oxygen saturation (SpO2) and body weight. Clinical data, self-measured at home according to a predetermined schedule based on the patient's risk profile, were automatically transmitted to the operating center, generating, if above the threshold, a grading of alarms (green/cyan, yellow, red) and the consequent activation of the most appropriate response (returned phone calls to check patient's status, reporting to primary physician/family practitioner for clinical evaluation, notification to the HF outpatient clinic for an early follow-up visit, alerting medical emergency services). The number of hospitalizations and ER visits during the TM period was compared with the pre-TM equivalent for each individual patient. Overall, 22 patients with chronic HF were enrolled (mean age 82.3 ± 8.6 years, 17 males). The average duration of TM was 18.7 ± 8.8 months. Overall, 62 108 home measurements were performed and transmitted. The alarms received by the operating center were 4120 (6.6% of all measurements): 62% cyan, 30% yellow, 8% red. Most of the data above the threshold concerned weight gain (42.0%) and SpO2 variations (28.0%). During the observation period (TM period and pre-TM equivalent interval calculated for each individual patient), a total of 127 hospitalizations and 181 ED visits were recorded. Compared to the pre-TM period, there was a 66% reduction in hospitalizations for all causes (95 vs 32, p<0.001) and a 68% decrease in ED visits (137 vs 44, p<0.001). Similarly, hospitalizations and ED visits due to HF were reduced by 82% (p<0.001) and 66% (p<0.001), respectively, with a decrease in days of HF-related hospitalization from 211 to 48. Despite a higher cost for TM of € 6911.15, a total saving of € 64 103.87 was obtained for the reduction of expenses from € 8665.45 to € 2664.00 for ED visits and from € 71 627.93 to € 13 525.51 for HF hospitalizations. This pilot experience on remote monitoring HF patients proved to be effective in determining a significant reduction in ED visits and hospitalizations with a consequent significant economic benefit. Larger studies are needed to confirm this favorable outcome.