Background:
Telemonitoring (Tel) of heart failure (HF) patients (pts) post discharge has had variable results. However, Tel systems have not always integrated delivery of relevant pt education. The purpose of this study was to examine outcomes after implementation of the Intel Health Guide System (HGS). HGS was deployed with AHA guideline-based HF protocols for clinical status, symptoms and delivery of relevant pt education to enhance pts’ understanding of and management of HF.
Methods:
Twenty-six pts post discharge with a HF diagnosis were enrolled. Based on the pts’ clinical status, AHA-HF protocols were deployed into the HGS to assess key vital signs and health questions daily, weekly, or monthly for 60 days. Pts and caregivers were trained in use of the HGS and related peripherals, response to scheduled sessions, and access of educational content independent of scheduled sessions. Health status was assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) pre and post monitoring.
Results:
Of 26 pts, 62% NYHA were Class II, 29% Class III. Mean age 75.2 ±10.1 yrs; 62% women; 39% African Americans; 23% ischemic. Mean EF = 47% ±16. Adherence was 88%. KCCQ Clinical and Overall scores increased significantly from 49±25 and 51±23 to 63±26 and 65±22, respectively (p=0.039). Thirteen pts (50%) were rehospitalized at mean of 16+5 days, 4 for HF and 9 for other reasons, (30 day rehospitalization rate = 23% all cause; 15% for HF). Median compliance (completing scheduled sessions) and utility (days with activity/monitored) for those not rehospitalized were greater (97.2%, 96.9%) than for those rehospitalized (67.4%, 82.6%; p=0.013, p=0.005, respectively). Using generalized estimating equations, greater utility but not compliance correlated with better health status’ clinical (p=0.013) and overall scores (p=0.0056).
Conclusions:
This observational study showed feasibility of adding AHA-HF guideline protocols and education content to the HGS. Health status improved post discharge. Although the rehospitalization rate was > 20%, pts who were not readmitted were more likely to have greater Tel utility and compliance. In addition, clinical and overall health status measures improved during the study, and were associated with greater pt utilization of the system.
Using Operational Analysis to Improve Access to Pulmonary Function Testing
