Home Monitoring Should Be the Central Element in an Effective Program of Heart Failure Disease Management
This review highlights current data on heart failure (HF) disease management, including telemonitoring and telemanagement. The following are 10 points to remember:
1. The goals of an HF disease management program should be to optimize patient treatment prescriptions, provide patient and caregiver education on the disease process and treatment plans, and provide ongoing monitoring of interventions undertaken and the patient’s condition.
2. For home monitoring to be most successful, it should contain all of the following: an ability for patients to transmit physiologic data, a means of data retrieval and analysis, prescription and implementation of a treatment plan, and continued monitoring with revised interventions based on information gained with follow-up.
3. Meta-analyses have demonstrated a reduction in HF admissions (13-21%) and mortality (20%-22%), with some evidence suggesting better outcomes with telemonitoring (daily weights, symptoms) compared with telephone support (scheduled nursing phone calls) alone.
4. The impact of HF management interventions tends to be more effective in reducing HF-related hospitalization rather than all-cause hospitalization. Approximately 50% of rehospitalizations after an HF admission are coded as non-HF related.
5. The author argues that some “negative” studies about telemonitoring failed because they lacked the key components of a telemanagement program, including standardized interventions and sufficient resources, and expertise to allow for necessary patient communication and care plans.
6. Since patient compliance with HF telemonitoring data input can be poor (adherence <55% in one study), the author argues that frequent interaction between the patient and the care team is obligatory for success of the intervention.
7. Telemonitoring with nurse interaction (but not telemonitoring alone) has been shown to improve quality-of-life measures in some studies.
8. Telemonitoring appears to be cost-effective, with some studies showing a societal cost of $15,000-18,000 per quality-adjusted life-year (QALY) gained and payer cost of $3,100-3,700 per QALY.
9. The impact of telemonitoring appears to be sustained after the intervention is discontinued. This is likely driven by improved patient knowledge about their disease process and medication adherence.
10. The role of implantable monitors (e.g., pulmonary artery sensory, impedance monitoring) in impacting HF outcomes and cost-effectiveness has yet to be elucidated.
Keywords: Medication Adherence, Electric Impedance, Heart Failure, Disease Management, Pulmonary Artery, Hospitalization, Patient Compliance, Quality-Adjusted Life Years, Information Storage and Retrieval, Caregivers, Goals
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