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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)192-199
Number of pages8
JournalInternational Journal of Cardiology
Volume131
Issue number2
DOIs
Publication statusPublished - Jan 9 2009

Keywords

  • Chronic heart failure
  • Disease management
  • Telecardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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