No Reduction in Readmissions with Telemonitoring, Coaching for Patients with Heart Failure
Am Fam Physician. 2016 Jul 15;94(2):168a-169.
Does a care transition intervention using telephone coaching and telemonitoring reduce readmissions for patients with heart failure?
A care transition intervention that incorporates remote monitoring of weight, blood pressure, and heart rate with scheduled telephone coaching did not reduce readmission rates at 30 days or 180 days for patients with heart failure. However, patients in the study were only modestly adherent to the intervention strategies. (Level of Evidence = 1b)
Hospitalized patients 50 years and older who were being actively treated for heart failure with expected discharge to home were randomized, using concealed allocation, to receive the care transition intervention (n = 715) or usual care (n = 722). The intervention consisted of the following: (1) predischarge heart failure education using teach-back methods, (2) postdischarge scheduled telephone coaching calls weekly for one month, then monthly for five months, and (3) home telemonitoring using a Bluetooth-enabled weight scale and blood pressure/heart rate monitor with texting ability. All interventions were conducted by registered nurses. Usual care included predischarge education and one postdischarge telephone call. There were no significant differences at baseline in the two groups. The median age was 73 years, and most of the participants were in New York Heart Association class III or IV. In the intervention group, adherence to the intervention strategies was modest; only 61% and 55% were adherent to telephone calls and telemonitoring, respectively, at 30 days. For the primary outcome of all-cause readmission at 180 days, there was no significant difference detected, with a high readmission rate in both groups of approximately 50%. Mortality was also similar at 180 days. Quality-of-life scores were improved in the intervention group at the end of the study; however, this likely reflects differences in survey respondents vs. nonrespondents.
Study design: Randomized controlled trial (nonblinded)
Funding source: Government
Setting: Inpatient (any location) with outpatient follow-up
Reference: Ong MK, Romano PS, Edgington S, et al. Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the Better Effectiveness After Transition-Heart Failure (BEAT-HF) randomized clinical trial. JAMA Intern Med. 2016;176(3):310–318.
POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.
For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.
To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Sep 15, 2017
Access the latest issue of American Family Physician