Use of ReDS Technology to Treat Heart Failure in the Home Health Setting

Abstract

Background Volume overload is a major determinant in the physical symptoms and quality of life in patients with heart failure (HF), as well as the predominant factor leading to HF admissions. Accurate assessment of a patient's volume status can be difficult. The Remote Dielectric Sensing (ReDS) Wearable System is an FDA-approved device developed by Sensible Medical Innovations that allows a health care provider to accurately, quickly and non-invasively measure lung fluid. In this study, we used the ReDS system to facilitate a nurse-led care transitions program to improve outcomes and reduce HF readmission rate in a rural hospital lacking an onsite HF program. Methods Randolph Hospital (RH) is a non-profit facility in central North Carolina with a 30-day HF readmission rate ≥ 25%. Medicare patients admitted for HF were enrolled into a nurse-led care transitions program. Patients received telephone follow up or home visit by a nurse within 3 days of discharge. Patients were instructed to call the care transitions nurse with any signs or symptoms of worsening HF during the follow-up period. If the patient complained of volume overload or increased dyspnea a nurse would travel to the patient's home to assess the patient and obtain a ReDS measurement. If the ReDS reading was consistent with volume overload (lung fluid > 35%), a specifically-designed diuretic protocol was initiated. Daily ReDS readings were performed and treatment protocol followed until the reading was below 35% or the protocol was stopped by the medical director. Renal function and electrolytes were monitored and replaced following pre-specified protocol. Results The Care Transitions Team has evaluated 61 patients thus far. There have been 32 elevated readings (ReDS > 35%) which triggered implementation of treatment using the diuretic-protocol. It took an average of 2.5 visits to titrate diuretics and obtain a reading Conclusions A nurse-led care transitions program employing ReDS technology and a specifically-designed diuretic protocol to manage HF patients post hospital discharge, was successful in reducing 30-day HF readmission and reduce overall resource utilization in a community hospital without a dedicated HF clinic.