JMIR Publications

ABSTRACT

Background:

Patients with heart failure (HF) can suffer from disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department (ED) or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits and improving quality of life.

Objective:

Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia (BC), Canada to prepare for launching a randomized controlled trial.

Methods:

Patients with HF were recruited from three urban hospitals and provided with HHM technology for 60 days of monitoring post-discharge. In our evaluation, the primary outcome was unscheduled, ED revisits of discharged participants or death within 90-days. Secondary outcomes included: hospital readmissions, patient participant health status (e.g., quality of life, self-efficacy), end-user experience, and health system cost-effectiveness, including cost reduction and hospital bed capacity. In this feasibility study, we tested the recruitment strategy, the clinical protocols, the evaluation framework and data collection methods, in addition to seeing if the data from this sample trended towards positive outcomes.

Results:

Our recruitment and clinical protocols were found to be acceptable overall to patients and health providers, and identified several issues that needed modification. Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 71% reduction of ED revisits post-monitoring, a 87% reduction in hospital readmissions, and a 60% reduction in the median length of stay (LOS). Cost of hospitalization for participants were reduced by 71.4% and ED visit costs dropped by 57.7%. Overall health system costs for our participants showed a 56% reduction post-monitoring. HF-specific quality of life (KCCQ-12) scores showed a significant increase of 100.8% post-monitoring (P<.001). General quality of life (VR-12) improved by 19.2% on the mental component score (P<.001) and 18.7% on the physical component score (P=.018). Self efficacy improved by 5.84%.

Conclusions:

Results from this feasibility study suggested that our HHM intervention can be beneficial in supporting patients post-discharge in a small sample. Additionally, key insights from the trial allowed us to refine our methods and procedures. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across BC. Clinical Trial: NCT03439384