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

A. Giordano, S. Scalvini, E. Zanelli, U. Corrà, Longobardi G.L., V. A. Ricci, P. Baiardi, F. Glisenti

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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.

Original languageEnglish
Pages (from-to)192-199
Number of pages8
JournalInternational Journal of Cardiology
Issue number2
Publication statusPublished - Jan 9 2009


  • Chronic heart failure
  • Disease management
  • Telecardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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