1. Among patients receiving inpatient treatment for decompensated heart failure, an outpatient intervention consisting of pre-discharge education, telephone coaching, and remote monitoring of daily vitals did not reduce readmission rates at 30 or 180 days compared to usual care. There was also no decrease in short-term mortality.
2. The intervention group did have significant non-adherence issues, wherein only about half of the group participated in at least 50% of the tele-monitoring and telephone calls, and about one-quarter of the group dropped out or was lost to follow up. This highlighted the challenge in implementing such an intervention.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Decompensated congestive heart failure (CHF) is a common reason for admission to the hospital and is associated with high rates of readmission after discharge. Proper management of the disease requires extensive patient education, and medication/lifestyle adherence. With growing penalties for hospital readmissions, there is a need for cost effective and practical interventions to reduce risk of CHF-related readmissions. Tele-monitoring has been one proposed intervention, but has had variable results.
This randomized controlled trial was done to evaluate the efficacy of a tele-monitoring intervention program in reducing CHF-related readmissions. Compared to patients receiving usual care, tele-monitoring intervention, which consisted of pre-discharge education, telephone coaching, and remote monitoring of daily vitals, did not reduce readmission rates at 30 or 180 days. There was also no decrease in short-term mortality. However, remote patient monitoring was associated with improved quality of life scores at 180 days. The strength of the study was design of the trial and studying a population that was generalizable. The weakness of the study was the limited participation amongst the intervention group, which decreased the validity of the results. Also, selection of patients may not have identified those at high risk for readmissions, for whom such an intervention may be most beneficial.
Relevant Reading: Telemonitoring in Patients with Heart Failure.
In-Depth [randomized controlled trial]: The presented study was a randomized controlled trial of patients (n = 1437) greater than 50 years-old who were admitted to the hospital and underwent treatment for decompensated heart failure. The purpose of the study was to determine if tele-monitoring after discharge could improve outcomes amongst this CHF population. Patients were excluded if they could not participate in the interventions, were already part of a more comprehensive follow-up, or had planned medical/surgical intervention for their CHF. The intervention consisted of a combination of pre-discharge HF education, telephone coaching by registered nurses, and remote monitoring of heart rate, blood pressure, weight, and symptoms.
The study arms did not differ in readmission at 30 days (22.7% vs 21.6%, p = 0.63), or 180 days (50.8% vs 49.2%, p = 0.39). Mortality at 30 days was lower for the intervention group (HR 0.53, 95%CI 0.31-0.93, p = 0.03), but was attributed to differences in in-hospital mortality after randomization rather than the intervention. There was no difference in 180-day mortality (14.0% vs 15.8%, p = 0.26). Mean quality of life scores at 180-days were 28.50 for the intervention group and 32.63 for the control group (p = 0.2). There was, however, significant non-adherence, drop-out, or loss of follow up in the intervention group.
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