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

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 o...

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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
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container_end_page 199
container_issue 2
container_start_page 192
container_title International journal of cardiology
container_volume 131
creator Giordano, A
Scalvini, S
Zanelli, E
Corrà, U
G.L., Longobardi
Ricci, V.A
Baiardi, P
Glisenti, F
description 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.
doi_str_mv 10.1016/j.ijcard.2007.10.027
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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 &lt; 0.01). Conclusions This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2007.10.027</identifier><identifier>PMID: 18222552</identifier><identifier>CODEN: IJCDD5</identifier><language>eng</language><publisher>Shannon: Elsevier Ireland Ltd</publisher><subject>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</subject><ispartof>International journal of cardiology, 2009-01, Vol.131 (2), p.192-199</ispartof><rights>Elsevier Ireland Ltd</rights><rights>2007 Elsevier Ireland Ltd</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-b39c29708eaee6e62fb54569a3504123a50227c310c43de15b2ea4344423785e3</citedby><cites>FETCH-LOGICAL-c445t-b39c29708eaee6e62fb54569a3504123a50227c310c43de15b2ea4344423785e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=21234388$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18222552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Giordano, A</creatorcontrib><creatorcontrib>Scalvini, S</creatorcontrib><creatorcontrib>Zanelli, E</creatorcontrib><creatorcontrib>Corrà, U</creatorcontrib><creatorcontrib>G.L., Longobardi</creatorcontrib><creatorcontrib>Ricci, V.A</creatorcontrib><creatorcontrib>Baiardi, P</creatorcontrib><creatorcontrib>Glisenti, F</creatorcontrib><title>Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>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 &lt; 0.01). Conclusions This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Chronic Disease</subject><subject>Chronic heart failure</subject><subject>Disease management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart Failure - economics</subject><subject>Heart Failure - therapy</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Home Care Services, Hospital-Based - economics</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Readmission - economics</subject><subject>Patient Readmission - trends</subject><subject>Telecardiology</subject><subject>Telemedicine - economics</subject><subject>Telemedicine - methods</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqFkk2L1TAUhoMoznX0H4hko7te89m0G0GG8QNGXKjrkKanNjVtapKOzM6fbuq9KLhxlXDyvIeTh4PQU0qOlND65XR0kzWxPzJCVCkdCVP30IE2SlRUSXEfHQqmKskUv0CPUpoIIaJtm4fogjaMMSnZAf38sPnsLCwZIo5m6cPsEvQ4R2c8DgsewwxVZ37XwMNsFvMV5sLjHPAa4Xa_jiGtLpdABNOXBsmVZBjwarIr7wn_cHnEdoxhcRaPYGLGg3F-i_AYPRiMT_DkfF6iL2-uP1-9q24-vn1_9fqmskLIXHW8taxVpAEDUEPNhk4KWbeGSyIo40YSxpTllFjBe6CyY2AEF0IwrhoJ_BK9OPVdY_i-Qcq6zGnBe7NA2JKuayVrIeoCihNoY0gpwqDX6GYT7zQlejevJ30yr3fze7WYL7Fn5_5bN0P_N3RWXYDnZ8Aka_xQZFuX_nCsfELwpincqxMHxcatg6iTLRIt9C6CzboP7n-T_NvAele8G_8N7iBNYYtLMa2pTkwT_Wnfkn1JiCK0lW3NfwHlALop</recordid><startdate>20090109</startdate><enddate>20090109</enddate><creator>Giordano, A</creator><creator>Scalvini, S</creator><creator>Zanelli, E</creator><creator>Corrà, U</creator><creator>G.L., Longobardi</creator><creator>Ricci, V.A</creator><creator>Baiardi, P</creator><creator>Glisenti, F</creator><general>Elsevier Ireland Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090109</creationdate><title>Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure</title><author>Giordano, A ; Scalvini, S ; Zanelli, E ; Corrà, U ; G.L., Longobardi ; Ricci, V.A ; Baiardi, P ; Glisenti, F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-b39c29708eaee6e62fb54569a3504123a50227c310c43de15b2ea4344423785e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Chronic Disease</topic><topic>Chronic heart failure</topic><topic>Disease management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart Failure - economics</topic><topic>Heart Failure - therapy</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Home Care Services, Hospital-Based - economics</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient Readmission - economics</topic><topic>Patient Readmission - trends</topic><topic>Telecardiology</topic><topic>Telemedicine - economics</topic><topic>Telemedicine - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Giordano, A</creatorcontrib><creatorcontrib>Scalvini, S</creatorcontrib><creatorcontrib>Zanelli, E</creatorcontrib><creatorcontrib>Corrà, U</creatorcontrib><creatorcontrib>G.L., Longobardi</creatorcontrib><creatorcontrib>Ricci, V.A</creatorcontrib><creatorcontrib>Baiardi, P</creatorcontrib><creatorcontrib>Glisenti, F</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Giordano, A</au><au>Scalvini, S</au><au>Zanelli, E</au><au>Corrà, U</au><au>G.L., Longobardi</au><au>Ricci, V.A</au><au>Baiardi, P</au><au>Glisenti, F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2009-01-09</date><risdate>2009</risdate><volume>131</volume><issue>2</issue><spage>192</spage><epage>199</epage><pages>192-199</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><coden>IJCDD5</coden><abstract>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 &lt; 0.01). Conclusions This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.</abstract><cop>Shannon</cop><pub>Elsevier Ireland Ltd</pub><pmid>18222552</pmid><doi>10.1016/j.ijcard.2007.10.027</doi><tpages>8</tpages></addata></record>
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ispartof International journal of cardiology, 2009-01, Vol.131 (2), p.192-199
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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
title Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure
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