Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure

• Published in: International journal of cardiology 2009-01, Vol.131 (2), p.192-199
• Main Authors: Giordano, A, Scalvini, S, Zanelli, E, Corrà, U, G.L., Longobardi, Ricci, V.A, Baiardi, P, Glisenti, F
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Chronic Disease; Chronic heart failure; Disease management; Female; Follow-Up Studies; Heart; Heart Failure - economics; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Home Care Services, Hospital-Based - economics; Humans; Male; Medical sciences; Middle Aged; Patient Readmission - economics; Patient Readmission - trends; Telecardiology; Telemedicine - economics; Telemedicine - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2007.10.027

Abstract Background Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for improving clinical outcomes. However, the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown. The aim of the study was to determine whether a home-based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow-up programme over a one-year period. Methods and results Four hundred-sixty CHF patients (pts), aged 57 ± 10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one-year hospital readmission for cardiovascular reasons. During one-year follow-up 55 pts (24%) in HBT group and 83 pts (36%) in UC group had at least one readmission (RR = 0.56; 95% CI: 0.38–0.82; p = 0.01). After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR = 0.50, 95% CI: 0.34–0.73; p = 0.01). The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group). The rate of hearth failure-related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR = 0.49, 95% [CI]: 0.31–0.76; p = 0.0001). No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was significantly lower in HBT group (€ 843 +/− 1733) than in UC group (€ 1298 +/− 2322), (− 35%, p < 0.01). Conclusions This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.