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ORLANDO, Fla. — Telemonitoring heart failure (HF) patients did not demonstrate a significant benefit, according to a study presented at the American Heart Association Scientific Sessions.
The BEAT-HF (Better Effectiveness After Transition – Heart Failure) study, a prospective, randomized clinical trial, sought to evaluate the effectiveness of care transition intervention using remote patient monitoring. Participants (N=1437) were 50 years of age or older, hospitalized, and receiving active treatment for decompensated HF. They received either intervention or usual care between October 2011 and September 2013 at 6 academic medical centers in California.
At a press conference, Michael K Ong, MD, PhD, of the University of California, Los Angeles and lead author, noted adherence concerns in past telemonitoring approaches, hypothesizing that newer technologies may improve engagement with patients.
The remote patient monitoring intervention included pre-discharge heart failure education; regularly scheduled telephone coaching sessions with a registered nurse beginning 2 to 3 days after hospital discharge; and use of telemonitoring equipment, which included daily use of Bluetooth-enabled weight scale and a blood pressure/heart rate monitor integrated with text device.
The primary outcome was 180-day all-cause readmission, and the secondary outcomes were 30-day all-cause readmission and 30-day and 180-day all-cause mortality.
Risk for readmission were similar between the intervention and usual care groups at 30 days (adjusted hazard ratio [HR]=1.01; 95% confidence interval [CI], 0.80 to1.28) and 180 days (adjusted HR=1.03; 95% CI, 0.88 to1.20), although the intervention was associated with lower risk for 30-day mortality (adjusted HR=0.53; 95% CI, 0.31 to 0.93) and 180-day mortality (adjusted HR=0.85; 95% CI, 0.64 to1.13).
Patients who were more adherent to the intervention appeared to have better outcomes. Compared with those who monitored their weight, blood pressure, and heart rate for half of the study period or less, patients with more than 50% of days monitored had lower rates of 30-day readmission (13.0% vs 34.6%), 180-day readmission (41.3% vs 61.1%), 30-day mortality (0.7% vs 6.6%), and 180-day mortality (6.6% vs 21.4%; P<.001 for all).
Similarly, patients who completed >50% of their scheduled calls with nurses, as compared with those who completed ≤50%, saw a significant reduction in 30-day readmission rates (14.9% vs 34.7%), 30-day mortality (0.6% vs 8.7%), and 180-day mortality (8.3% vs 26.0%; P<.001 for all). However, 180-day readmission was not significantly different between groups (49.6% vs 54.0%).
Two of the study’s limitations included a lack of integration with the patients’ physician practices and the rapidly changing technology landscape. In fact, Dr Ong noted that when the study began in 2010, “Blackberries were still the dominant smartphone; it’s a different age now.”
Advances in the electronic medical records system could improve the quality of care in the future.
Dr Ong concluded that further studies are needed to confirm whether or not fewer readmissions and deaths are impacted by levels of patient adherence.
Reference
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Ong Michael K. LBCT.01 – Failure is Not an Option: New Drugs and Systems of Care. Remote patient management after discharge of hospitalized heart failure patients: the Better Effectiveness After Transition – Heart Failure (BEAT-HF) study. Presented at the American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.
