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A K Woodend
Dr A K Woodend, University of Ottawa, Ottawa, Ontario, Canada;
In patients with heart failure (HF) or angina who are at high risk for hospital readmission, does telehome monitoring reduce readmissions and improve functional status and quality of life?
randomised controlled trial (RCT).
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
249 patients (mean age 66 y, 75% men) who had symptomatic HF or angina. Patients discharged to another institution or to long-term care were excluded.
telehome monitoring (n = 124) or usual care (n = 125). Telehome monitoring comprised 3 months of video conferencing (⩾ once/wk) with a nurse (assessment of patient progress and self-care education), daily transmission of weight and blood pressure, and periodic transmission of 12-lead electrocardiogram.
included hospital readmission, use of healthcare resources (emergency department [ED], health professional, or home care visits), functional status (Minnesota Living with Heart Failure questionnaire [LiHFe] or Seattle Angina Questionnaire [SAQ]), and quality of life (Medical Outcomes Study Short Form 36 [SF-36]).
94% (intention-to-treat analysis).
At 3 months, the telehome group had fewer hospital readmissions and fewer days in hospital than the usual care group, but groups did not differ at 1 year (table). Groups did not differ for number of ED, health professional, or home care visits, or overall LiHFe scores. In the subgroup of patients with angina, the telehome group had fewer ED visits/person than the usual care group at 3 months (0.15 v 0.35, p = 0.04) and 1 year (0.31 v 0.83, p = 0.01). The telehome group had greater improvements in SAQ scores for the subscales of exertional capacity and treatment satisfaction (table). At 1 year, the telehome group had better SF-36 scores for physical functioning (p = 0.008), bodily pain (p = 0.009), vitality (p = 0.015), and social functioning (p = 0.023) subscales.
Telehome monitoring reduced hospital readmissions and improved quality of life in patients with heart failure or angina who were at high risk for readmission.
*Information provided by author.
Woodend AK, Sherrard H, Fraser M, et al. Telehome monitoring in patients with cardiac disease who are at high risk of readmission. Heart Lung 2008;37:36–45.
Clinical impact ratings: Cardiology 6/7; Family/general practice 6/7; General/internal medicine 7/7
Telehome monitoring has appeal as an alternative to conventional modes of healthcare delivery because it improves access and management in a familiar, and probably more suitable, environment and has potential for cost savings. 2 recent systematic reviews1 2 suggest it may be effective in patients with chronic HF, although no studies have assessed its effectiveness in other cardiac populations at high risk of readmission.
The RCT by Woodend et al showed that telehome monitoring reduced readmissions and improved quality of life in patients with HF or angina, but, surprisingly, the benefits were more statistically and clinically important in patients with angina than in those with HF. More patients with HF visited health professionals and received homecare visits than patients with angina (22% v 7%, p = 0.003), which reflects the severity of the condition. In addition, the telehome monitoring group found the technology easy to use and were satisfied. A cost-effectiveness analysis of the intervention is underway.
The study supports a growing body of evidence attesting to the benefits of telehome monitoring as a viable disease management strategy for patients at high risk of readmission. In this regard, it appears that the intervention can be recommended for patients with HF, although caution is advised regarding its use in patients with angina until cost-effectiveness data are available. If these data appear favourable, one can be more confident considering introducing telehome monitoring to similar patients in clinical practice. However, until other studies confirm these findings, it might be premature to recommend widespread introduction into routine practice.
Source of funding: Richard Ivey Foundation; Change Foundation; Merck-Frosst Canada.
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