JMIR Publications

ABSTRACT

Background:

Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decisions. A HF TM program which provides patients with personalized self-care support and clinicians with the opportunity to actively manage patients remotely has been operating for 3 years as part of the standard of care in an outpatient heart function clinic in Toronto, Canada.

Objective:

The objective of this study was to evaluate the 6-month impact of this TM program on health service utilization, clinical outcomes, quality of life (QoL), and patient self-care.

Methods:

This pragmatic quality improvement study employed a pretest-posttest design to compare 6-month outcome measures to those at program enrollment. The primary outcome was the number of HF-related hospitalizations. Secondary outcomes included all-cause hospitalizations, emergency department visits (HF-related and all-cause), length of stay (HF-related and all-cause), and visits to the outpatient clinic. Clinical outcomes included bloodwork (B-Type Natriuretic Peptide (BNP), creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the EQ-5D-5L. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). Difference in outcome scores were analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables.

Results:

Available data for all 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (IRR=.50, P<.001) and a 24% decrease number of all-cause hospitalizations (IRR=.76, P=.02) was found when comparing the number of events 6 months after program enrollment to the number of events 6 months before enrollment. With respect to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. 6-month MLHFQ total scores were 9.8 points lower than baseline scores (P<.001), representing a clinically meaningful improvement in HF-related QoL. Likewise, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (P<.001) and 1.5 points (P= .04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (P<.001) and 8.5-point (P=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes assessed.

Conclusions:

This study suggests that a HF TM program which provides patients with self-care support and active clinical monitoring by their existing care team can reduce health service utilization as well as improve clinical, quality of life, and patient self-care outcomes.