Impact of patient-centred home telehealth programme on outcomes in heart failure

2018 ◽  
Vol 25 (7) ◽  
pp. 425-430 ◽  
Author(s):  
Anshul Srivastava ◽  
Jacquelyn-My Do ◽  
Virna L Sales ◽  
Samantha Ly ◽  
Jacob Joseph
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Urgent Care ◽  
Control Group ◽  
Emergency Room Visits ◽  
Total Hospital ◽  
Heart Failure Patients ◽  
Home Telehealth ◽  
One Year ◽  
Hospital Days

Background Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure. Methods We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits. Results Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 ± 3.5) in comparison to the previous year without monitoring (4.1 ± 4.6, p < 0.0001) and to the control group (3.8 ± 5.3, p < 0.001). A significantly lower admission rate (1.1 ± 1.6) and length of stay (5.7 ± 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 ± 1.7, p < 0.05 and 9.5 ± 14 days, p < 0.01 respectively) but not in comparison with the control group (1.4 ± 2.0, p < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 ± 11.3 vs 9.0 ± 14.9, p < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year. Conclusions Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.

Abstract 3524: Implementation of the American Heart Association Get With the Guidelines Heart Failure Program (GWTG-HF) Reduces Length of Stay and Decreases Cost for Hospitalized Heart Failure Patients at St. Joseph’s Regional Medical Center (SJRMC)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert T Faillace ◽  
Richard B Siegrist ◽  
Steven Duchensky ◽  
Lorraine Marut ◽  
Ilene Matza ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Direct Cost ◽  
Average Length ◽  
Standards Of Care ◽  
Contribution Margin ◽  
Heart Failure Patients ◽  
Average Length Of Stay ◽  
Hospital Days ◽  
Multi Disciplinary Team

Hospitalized heart failure patients (HF) may not consistently receive standards of care and hospitals frequently realize a financial loss in the care of HF patients. GWTG-HF makes it more likely to ensure optimal care, decrease direct cost and increase hospital profit in the management of HF patients. HYPOTHESIS: Utilization of GWTG-HF with a multi-disciplinary team would be associated with a consistent application of standards of care, shorter duration of hospitalization and less direct cost for hospitalized HF patients. METHODS: GWTG-HF was fully operational in 2006 with a multi-disciplinary team consisting of a Physician Champion, Advanced Practice Nurses (APNs), Case Managers and RNs. APNs utilized GWTG-HF at the point of service and worked collaboratively with attending physicians. We compared the average length of stay, total number of hospitalized days, patient revenue, total direct cost, contribution margin, and the profit/loss for hospitalized HF patients in 2005 to those in 2006. RESULTS: There were 773 cases of HF admissions in 2005 as compared to 781 in 2006. Overall compliance with GWTG-HF Core Measures in 2006 was 98% (HF-1 D/C Instructions 99%; HF-2 Left ventricular systolic (LVS) function evaluation 96%; HF-3 ACEI/ARB for LVS dysfunction 98%; HF-4 Smoking cessation advice 100%; Beta Blocker Use 95%). The average length of stay (LOS) in 2005 was 6.7 days as compared to 6.3 days in 2006 (p <0.02). The total number of hospital days in 2005 was 5,145 as compared to 4,880 in 2006 (p<0.02). Between 2005 and 2006 patient revenue increased by $279,847 (p<0.01), direct cost decreased by $348,014 (p<0.05), contribution margin increased by $627,861 (p=0.06) and the full cost profit margin increased by $309,460 (NS). CONCLUSION: Utilization of GWTG-HF at SJRMC is associated with a high compliance with standards of hospitalized HF care, decrease in average LOS, decrease in total number of hospital days and decrease in direct cost. Although not statistically significant, hospital contribution margin and profit increased for acutely decompensated HF patients.

scholarly journals Anger and depression predict hospital use among chronic heart failure patients

2009 ◽  
Vol 33 (4) ◽  
pp. 541 ◽  
Author(s):  
Roslyn C Jenner ◽  
Robert D Schweitzer ◽  
Esben S Strodl
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Length Of Stay ◽  
Medical Records ◽  
Hospital Readmissions ◽  
Illness Severity ◽  
Ageing Population ◽  
Health Profile ◽  
Heart Failure Patients ◽  
One Year

Costly hospital readmissions among chronic heart failure (CHF) patients are expected to increase dramatically with the ageing population. This study investigated the prognostic ability of depression, anger and anxiety, prospectively, and after adjusting for illness severity, on the number of readmissions to hospital and the total length of stay over one year. Participants comprised 175 inpatients with CHF. Depression, anger, anxiety, and illness severity were measured at baseline. One year later, the number of readmissions and length of stay for each patient were obtained from medical records. Depression and anger play a detrimental role in the health profile of CHF patients.

scholarly journals Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions

2018 ◽  
Vol 11 (4) ◽  
Author(s):  
Lisa M. Fleming ◽  
Xin Zhao ◽  
Adam D. DeVore ◽  
Paul A. Heidenreich ◽  
Clyde W. Yancy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Early Ambulation ◽  
Heart Failure Patients

Long-term effectiveness of telephone-based health coaching for heart failure patients: A post-only randomised controlled trial

2016 ◽  
Vol 23 (8) ◽  
pp. 716-724 ◽  
Author(s):  
Michel Tiede ◽  
Sarah Dwinger ◽  
Lutz Herbarth ◽  
Martin Härter ◽  
Jörg Dirmaier
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Locus Of Control ◽  
Controlled Trial ◽  
Health Coaching ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Heart Failure Patients ◽  
Health Related

Introduction The * Equal contributors. health-status of heart failure patients can be improved to some extent by disease self-management. One method of developing such skills is telephone-based health coaching. However, the effects of telephone-based health coaching remain inconclusive. The aim of this study was to evaluate the effects of telephone-based health coaching for people with heart failure. Methods A total sample of 7186 patients with various chronic diseases was randomly assigned to either the coaching or the control group. Then 184 patients with heart failure were selected by International Classification of Diseases (ICD)-10 code for subgroup analysis. Data were collected at 24 and 48 months after the beginning of the coaching. The primary outcome was change in quality of life. Secondary outcomes were changes in depression and anxiety, health-related control beliefs, control preference, health risk behaviour and health-related behaviours. Statistical analyses included a per-protocol evaluation, employing analysis of variance and analysis of covariance (ANCOVA) as well as Mann-Whitney U tests. Results Participants’ average age was 73 years (standard deviation (SD) = 9) and the majority were women (52.8%). In ANCOVA analyses there were no significant differences between groups for the change in quality of life (QoL). However, the coaching group reported a significantly higher level of physical activity ( p = 0.03), lower intake of non-prescribed drugs ( p = 0.04) and lower levels of stress ( p = 0.02) than the control group. Mann-Whitney U tests showed a different external locus of control ( p = 0.014), and higher reduction in unhealthy nutrition ( p = 0.019), physical inactivity ( p = 0.004) and stress ( p = 0.028). Discussion Our results suggest that telephone-based health coaching has no effect on QoL, anxiety and depression of heart failure patients, but helps in improving certain risk behaviours and changes the locus of control to be more externalised.

Abstract 17667: Local Atrophy of Parahippocampal Gyrus is Prominent in Heart Failure Patients Without Dementia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tomomi Meguro
Keyword(s):  
Heart Failure ◽  
Cognitive Impairment ◽  
Potential Risk ◽  
Brain Atrophy ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Parahippocampal Gyrus ◽  
Control Group ◽  
Z Score ◽  
Heart Failure Patients

Introduction: The exacerbation of heart failure (HF) induces brain damage and the cognitive impairment that attenuates the effects of treatment. The medial lateral lobe of brain, including parahippocampal gyrus, is known to reduce its volume in patients with cognitive disorder especially in Alzheimer’s disease. The magnetic resonance imaging (MRI) scans identify morphological changes in the brains of patients with HF. Therefore, the Voxel-based morphometry (VBM) of three-dimensional brain MRI may contribute to predict the potential risk of mild cognitive impairment (MCI) of patients with HF. Hypothesis: The severity of local atrophy of parahippocampal gyrus, a potential risk of MCI, is prominent in heart failure patients without dementia. Methods: Ten HF patients (age 72+/-15 years, NYHA class II, EF43+/-15 %) and 9 control (age 76+/- 8 years) were enrolled. Patients with dementia were excluded from this study. Three dimensional T1 weighted sagittal images of whole brain were taken using 1.5T MRI. Image analysis was performed to evaluate the severity of local brain atrophy of gray matter using 2mm VBM by the software based on statistical parametric mapping. The Z-score value of volume of interest (VOI) was calculated to evaluate the severity of atrophy in parahippocampal gyrus. Results: The severity of total brain atrophy was similar between HF (8.3+/-3.4%) and control (8.0+/-4.1%). However, as shown in the figure of representative cases, the Z-score value of VOI (pink circle), reflecting the severity of atrophy in parahippocampal gyrus (white arrows), was larger in HF patients group (1.4+/-0.7) in comparison with control group (0.8+/-0.4, P=0.034). The Z-score value was not correlated with age, ejection fraction, left atrial dimension, left ventricular dimensions, or BNP in HF group. Conclusions: In patients with HF, atrophy in parahippocampal gyrus was prominent in comparison with control. Patients with heart failure have potential risk of MCI and dementia.

Total Population Estimate of Newborn Special-Care Bed Needs

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 993-996
Author(s):  
August L. Jung ◽  
Nan Sherman Streeter
Keyword(s):  
Length Of Stay ◽  
Total Population ◽  
Average Length ◽  
Special Care ◽  
Care Hospital ◽  
Total Hospital ◽  
Live Births ◽  
Average Length Of Stay ◽  
Study Results ◽  
Hospital Days

In 1977, 7% of the 38,855 infants born in Utah were estimated to have required a total of 27,439 special-care hospital days. About half (53%) were mildly ill; their average length of stay was 4.6 days, or 24% of the total hospital-days. Another 20% of the infants had intermediate illness, with a 12-day average stay, or 23% of the total hospital-days. The remaining 27% of the infants required intensive care and used 53% of the total hospital-days; their average length of stay was 20 days. As a total population, the state's 38,855 births generated a need for two beds per 1,000 annual live births in special-care facilities. The estimated bed need was: mild illness (Level I), 0.5 beds per 1,000 annual live births; intermediate illness (Level II), 0.5 beds per 1,000 annual live births; and intense illness (Level III), one bed per 1,000 annual live births. Results are based on the assumption that nonstudy births, 30% of the total, have needs proportionate to study births. The following considerations are necessary to extrapolate these bed needs to other populations: (1) convalescence of intensely ill babies may require that up to 50% of their bed needs may be shifted to intermediate care; (2) compliance with criteria for transport to the next level of care may not be 100% as assumed in the study, thus redistributing bed needs; (3) census characteristically fluctuates in special-care nurseries (study results are reported for an unchanging daily census); and (4) the low birth rate of a population is intimately related to the bed needs.

scholarly journals The Impact of Treatment with Beta-Blockers upon Mortality in Chronic Heart Failure Patients

2016 ◽  
Vol 4 (1) ◽  
pp. 94-97 ◽  
Author(s):  
Borjanka Taneva ◽  
Daniela Caparoska
Keyword(s):  
Heart Failure ◽  
Relative Risk ◽  
Chronic Heart Failure ◽  
Beta Blocker ◽  
Cardiovascular Mortality ◽  
Conventional Therapy ◽  
Therapy Group ◽  
Beta Blockers ◽  
Control Group ◽  
Heart Failure Patients

BACKGROUND: Besides the conventional therapy for heart failure, the diuretics, cardiac glycosides and ACE-inhibitors, current pharmacotherapy includes beta-blockers, mainly because of their pathophysiological mechanisms upon heart remodeling.AIM: The study objective was to assess the cardiovascular mortality in the beta-blocker therapy group and to correlate it with the mortality in the control group as well as to correlate the combined outcome of death and/or hospitalization for cardiovascular reason between the two groups.               MATERIALS AND METHODS: The study included 113 chronic heart failure patients followed up for a period of 18 months. The therapy group received conventional therapy plus the target dose of beta blockers, and the control group received the conventional therapy only. The therapy group was divided in three separate subgroups in terms of the type of beta-blocker (Metoprolol subgroup, Bisoprolol and Carvedilol subgroup). To compare the mortality and the combined outcome, the RRR (relative risk reduction) and NNT (number needed to treat) were used, as well as the survival analysis by Kaplan-Meier.RESULTS: The results showed the following: in regards of the cardiovascular mortality, the relative risk for death in the therapy group was 34%, which, though statistically not significant, is of great clinical significance. In regards of the combined outcome (death and/or number of hospitalizations) the results showed a RRR of 40% in the therapy group compared to the control group, which is statistically highly significant.CONCLUSION: The study confirmed that patients with stable chronic heart failure, treated with optimal doses of beta-blockers, show a significant reduction of the risk from death as well as combined outcome (death and/or number of hospitalizations).

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