Abstract

Nurse Telemanagement (NTM) yielded better outcomes for heart failure than home nurse visits. Maintaining optimally compensated states via NTM may decrease HF readmissions, shorten LOS, reduce hospital charges and improve QOL. Frequent monitoring, prompt response and intervention facilitated by NTM may be a critical factor for improved HF outcomes. Background: Experts agree that outpatient care may be a contributing factor to poor outcomes in heart failure, affecting nearly 5 million Americans. HF is the most common discharge diagnosis and indication for hospitalization in patients over 65 years of age. Incidence and prevalence in HF is expected to rise as the population ages. Frequent occurrences of decompensated chronic HF are a major problem in outpatient care requiring shifts to more costly inpatient care. This study hypothesized that decompensation is preceded by changes in vital signs, and if detected early, hospital readmissions can be avoided. Outcomes (HF readmissions, length of stay [LOS], hospitalization charges and quality of life [QOL]) were compared for HF patients requiring home care provided by: (a) nurse telemanagement (NTM) or (b) home nurse visits (HNV).

Method: Two hundred and sixteen patients admitted to UIC and WSVA medical centres between April 1997 and July 2000 were randomized to either NTM or HNV for 3 months following discharge. NTM featured use of a home monitor which automatically notifies patients to obtain their vital signs (blood pressure, heart rate, arterial oxygen saturation, and weight). Patient data are transmitted via telephone line to a server accessed by an advanced practice nurse (APN), cardiology fellow and attending cardiologist. The APN is notified automatically via pager when patient data falls outside set parameters. The patient's phone number is also transmitted to facilitate prompt intervention. HVN featured 9 to 12 visits by specialized cardiac nurses (from one of three home health care agencies) following specified HF program and clinical pathways based on the American Heart Care and Policy Research guidelines. Outcomes were measured at post-intervention and 6 and 12 month follow-up.

Findings: Mean age of participants was 63 years. No statistically significant differences were found between groups with respect to receipt of ACE inhibitors or beta-blockers [drugs known to improve HF outcomes]. The NTM group had fewer admissions and fewer admissions (11% vs. 23%), shorter LOS (45 vs. 105 days), and less hospitalization charges compared to the HVN group at 3 months. The NTM group had lower readmission rates and cumulative hospitalization charges ($224 thousand vs. $500 thousand) at 6 and 12 months. QOL improved for both groups post interventions.

Conclusions: Management strategies aimed at maintaining optimally compensated states may decrease HF readmissions, shorten LOS, reduce hospital charges and improve QOL. This study suggests that frequent monitoring, prompt response and intervention facilitated by NTM may be a critical factor for improved HF outcomes.

Reference: Benator D, Bondmass M, Ghitelman J, Avitall B. Outcomes of Chronic Heart Failure. Archives of Internal Medicine 2003; 163, Feb. 10: 347-352.