Randomized trial of Telemonitoring to Improve Heart Failure Outcomes (Tele-HF): study design. [Monitoring multiple cardiovascular paramaters using telemedicine in patients with chronic heart failure]. Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study A Randomized Trial of Telemonitoring Heart Failure Patients Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease. Impact of telemonitoring at home on the management of elderly patients with congestive heart failure Telemonitoring in heart failure patients treated by cardiac resynchronisation therapy with defibrillator (CRT-D): the TELECART Study. Predictors of a sustained response to exercise training in patients with chronic heart failure: a telemonitoring study. Strategy to recognize and initiate treatment of chronic heart failure in primary care (STRETCH): a cluster randomized trial Tele-guidance of chronic heart failure patients enhances knowledge about the disease. A multi-centre, randomised controlled study. Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition - Heart Failure (BEAT-HF) randomized controlled trial Telemonitoring of heart failure patients and their caregivers: a pilot randomized controlled trial.
BACKGROUND Telemonitoring , the use of communication technology to monitor clinical status , is gaining attention as a strategy to improve the care of patients with heart failure . A system of frequent monitoring could alert clinicians to early heart failure decompensation , providing the opportunity for intervention before patients become severely ill and require hospitalization . Moreover , patients ' participation in a daily monitoring program could have a favorable effect on their health behaviors . The literature on telemonitoring for heart failure , however , is quite limited . METHODS AND MATERIAL S Telemonitoring to Improve Heart Failure Outcomes ( Tele-HF ) is a r and omized , controlled , trial design ed to compare an automated , daily symptom , and self-reported weight monitoring intervention with usual care in reducing ( all-cause ) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure . The intervention will be implemented and all outcomes will be assessed over a 6-month period . The purpose of the intervention is to collect information about symptoms , clinical status and weight and to engage participants in their own self-care .  Participants are recruited from general cardiology , heart failure specialty , and primary care practice s across the United States . CONCLUSIONS The results of this study may inform future policy decisions regarding implementation of telemonitoring in treatment of heart failure Progression of chronic heart failure depends on various additional pathophysiologic factors like blood pressure , arrhythmias , congestion . Early detection of any alteration using telemonitoring of multiple vital parameters may avoid severe decompensation requiring hospital admission . The feasibility and the clinical outcome using a new telemonitoring device for recording multiple vital parameters and allowing communication on individual state of health is investigated . Twenty-four patients with chronic heart failure ( mean age 65 years , mean LV ejection fraction 35 % ) requiring at least one hospital admission during the past year were investigated . Twice a day , the vital-parameters were measured ( weight , blood pressure , heart rate and rhythm , oxygen saturation , respiration rate ) and patients information on well being , shortness of breath , medication , and request for contact were received . Intra-individual comparison was carried out between the 12 month before inclusion in this study and 12 month under telemonitoring surveillance ( extrapolated , if necessary ) . Performing over 10 500 measurements during 5751 patient days , critical events were diagnosed for 55 events concerning relative weight gain ( 43 episodes ) , blood pressure ( 6 ) , decrease in oxygen saturation ( 3 ) , new onset of atrial fibrillation with tachyarrhymia ( 3 ) . Of these , 45 events were controlled on an outpatient basis by changing medication or external cardioversion . Only 10 patients required re-admission . Thus , the number of admission to the hospital could be reduced by 62 % , those of days spent in hospital by 69 % . Non-invasive telemonitoring of multiple vital parameters combined with patients statements on their health condition and out-patient treatment on the basis of these findings is found to be an effective and reliable approach to avoid hospital readmission for patients with chronic heart failure Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient 's home . The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions . Methods / design A primary care-based r and omised controlled trial will be carried out to assess the impact of a telemonitoring intervention aim ed at home care patients with heart failure ( HF ) and /or chronic lung disease ( CLD ) . The results will be compared with those obtained with st and ard health care practice . The duration of the study will be of one year . Sixty patients will be recruited for the study . In-home patients , diagnosed with HF and /or CLD , aged 14 or above and with two or more hospital admissions in the previous year will be eligible . For the intervention group , telemonitoring will consist of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight and body temperature . Additionally , the patients will complete a qualitative symptom question naire daily using the telemonitoring system . Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits . The control group will receive usual care . The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-r and omisation . The secondary outcome measures are : duration of hospital stay , hospital admissions due to HF or CLD , mortality rate , use of health care re sources , quality of life , cost-effectiveness , compliance and patient and health care professional satisfaction with the new technology . Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting . The study may contribute to enhance the underst and ing of alternative modes of health care provision for medically unstable elderly patients , who bear a high degree of physical and functional deterioration . Trial Registration IS RCT N : IS RCT EXECUTIVE SUMMARY The purpose of this study was to measure the ability of telemonitoring to reduce hospital days and total costs for Medicare managed care enrollees diagnosed with heart failure . Patients were recruited and r and omly assigned for six months to either  telemonitoring or st and ard care . Telemonitoring transmitted vital signs and clinical alerts daily to a central nursing station . Utilization of covered services was analyzed for the six‐month telemonitoring period to test for hypothesized reductions in hospital days and changes in utilization of the emergency department ( ED ) , urgent care , and primary care . Negative binomial regressions adjusted for gender , age , co‐occurring diabetes , co‐occurring chronic obstructive pulmonary disease , and residence neighborhood were used to analyze units of service , and two‐part ( hurdle ) multivariable models were used for expenditures . The main finding was a tendency for lower total number of hospital days for patients assigned to telemonitoring . Results for other covered services were generally consistent with hypothesized direction and magnitude ; however , statistical power was reduced because of lowerthan‐expected recruitment rates into the study . Within a managed‐care environment , telemonitoring appears to facilitate better ambulatory management of heart failure patients  , including fewer ED visits , which were offset by more frequent primary care and urgent care visits AIMS Chronic heart failure ( CHF ) patients are frequently rehospitalized within 6 months after an episode of fluid retention . Rehospitalizations are preventable , but this requires an extensive organization of the healthcare system . In this study , we tested whether intensive follow-up of patients through a telemonitoring-facilitated collaboration between general practitioners ( GPs ) and a heart failure clinic could reduce mortality and rehospitalization rate . METHODS AND RESULTS One hunderd and sixty CHF patients [ mean age 76 ± 10 years , 104 males , mean left ventricular ejection fraction ( LVEF ) 35 ± 15 % ] were block r and omized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by telemonitoring ( TM ) or usual care ( UC ) . The TM group measured body weight , blood pressure , and heart rate on a daily basis with electronic devices that transferred the data automatically to an online data base . Email alerts were sent to the GP and heart failure clinic to intervene when pre-defined limits were exceeded . All-cause mortality was significantly lower in the TM group as compared with the UC group ( 5 % vs. 17.5 % , P = 0.01 ) . The total number of follow-up days lost to hospitalization , dialysis , or death was significantly lower in the TM group as compared with the UC group ( 13 vs. 30 days , P = 0.02 ) . The number of hospitalizations for heart failure per patient showed a trend ( 0.24 vs. 0.42 hospitalizations/patient , P = 0.06 ) in favour of TM . CONCLUSION Telemonitoring-facilitated collaboration between GPs and a heart failure clinic reduces mortality and number of days lost to hospitalization , death , or dialysis in CHF patients . These findings need confirmation in a large trial Background The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention Background Previous trials of telemonitoring for heart failure management have reported inconsistent results , largely due to diverse intervention and study design s. Mobile phones are becoming ubiquitous and economical , but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined . Objective The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes . Methods One hundred patients were recruited from a heart function clinic and r and omized into telemonitoring and control groups . The telemonitoring group ( N = 50 ) took daily weight and blood pressure readings and weekly single-lead ECGs , and answered daily symptom questions on a mobile phone over 6 months . Readings were automatically transmitted wirelessly to the mobile phone and then to data servers . Instructions were sent to the patients ’ mobile phones and alerts to a cardiologist ’s mobile phone as required . Results Baseline question naires were completed and returned by 94 patients , and 84 patients returned post- study question naires . About 70 % of telemonitoring patients completed at least 80 % of their possible daily readings . The change in quality of life from baseline to post- study , as measured with the Minnesota Living with Heart Failure Question naire , was significantly greater for the telemonitoring group compared to the control group ( P = .05 ) . A between-group analysis also found greater post- study self-care maintenance ( measured with the Self-Care of Heart Failure Index ) for the telemonitoring group ( P = .03 ) . Brain natriuretic peptide ( BNP ) levels , self-care management , and left ventricular ejection fraction ( LVEF ) improved significantly for both groups from baseline to post- study , but did not show a between-group difference . However , a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post- study in BNP ( decreased by 150 pg/mL , P = .02 ) , LVEF ( increased by 7.4 % , P = .005 ) and self-care maintenance ( increased by 7 points , P = .05 ) and management ( increased by 14 points , P = .03 ) , while the control group did not . No differences were found between the telemonitoring and control groups in terms of hospitalization , mortality , or emergency department visits , but the trial was underpowered to detect differences in these metrics . Conclusions Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system . The use of the mobile phone-based system had high adherence and was  feasible for patients , including the elderly and those with no experience with mobile phones . Trial Registration Clinical Trials.gov AIMS Heart failure chiefly affects the elderly , with frequent emergency admissions . Telemonitoring can identify worsening heart failure but previous r and omized trials have enrolled selected patient population s. The Home-HF study examined the impact of home telemonitoring on typical heart failure patients discharged from three acute hospitals in North West London , UK . METHODS AND RESULTS Patients hospitalized with heart failure were r and omized to telemonitoring or usual specialist care . Primary outcome measures were days alive and out of hospital . Secondary outcome measures were number and duration of heart failure hospitalizations , clinic visits , and quality of life .  We recruited 182 patients . There was no difference in the primary outcome measure in the two groups , but there were significantly fewer unplanned hospitalizations for heart failure decompensation , and a reduction in clinic and emergency room visits in the telemonitoring group . There was no statistically significant difference in the mean direct health service costs . CONCLUSION Home telemonitoring in a typical elderly population of heart failure patients produces a similar outcome to ' usual ' specialist care , but reduces clinic and emergency room visits and unplanned heart failure rehospitalizations at little additional cost . This method of disease monitoring may allow specialist services to increase the number of patients under their care OBJECTIVES Cardiovascular diseases are the most frequent cause of death in industrialized countries . Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events . The telemonitoring programme MyCor ( Myokardinfarkt und Koronarstent Programm in Tirol ) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease ( CHD ) . It includes patient education , self-monitoring with goal - setting and feedback , and regular clinical visits . We evaluated the MyCor telemonitoring programme regarding technical feasibility , user acceptance , patient adherence , change in health status , and change in quality of life . METHODS A 4½-month study was conducted with two telemonitoring phases and one interim phase . The study comprised patient surveys , st and ardized assessment of quality of life using the MacNew question naire at study entry and after 4 and 18 weeks , analysis of adherence to medication and physical activity during the two telemonitoring phases , and analysis of reached goals regarding health conditions during the telemonitoring phases . RESULTS Twenty-five patients ( mean age : 63 years ) participated in the study . Patients showed a high acceptance of the MyCor telemonitoring programme . Patients reported feelings of self-control , motivation for lifestyle changes , and improved quality of life . Adherence to daily measurements was high with 86 % and 77 % in the two telemonitoring phases . Adherence to medication was also high with up to 87 % and 80 % . Pre-defined goals for physical activity were reached in up to 86 % and 73 % of days , respectively . Quality of life improved from 5.5 at study entry to 6.3 at the end ( p < 0.01 ; MacNew question naire ) . Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed . CONCLUSIONS The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients . Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes . Achieving long-term adherence and verifying clinical outcomes , however , remains an open issue . Our findings will promote further studies , addressing different strategies for an optimal mix of patient education , telemonitoring , feedback , and clinical follow-ups We studied the effects of home telemonitoring in elderly patients with congestive heart failure ( CHF ) on mortality and rate of hospitalization , compliance with treatment , quality of life and costs of CHF management , by comparison with a group receiving usual care . Fifty-seven elderly CHF patients were r and omized to st and ard care or to home telemonitoring-based care  and followed for 12 months . In the subjects who were monitored , weekly reports on their clinical status were obtained and their management was modified accordingly . Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations ( P = 0.006 ) , a better compliance with therapy , more frequent use of beta-blockers and statins , lower total cholesterol level and a better reported health perception score . The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients AIM Telemonitoring ( TM ) is a safe and efficient monitoring system for internal cardioverter defibrillator device ( ICD ) recipients . TM has been used to track info on the clinical status of heart failure patients treated by ICD and /or cardiac resynchronisation therapy defibrillator ( CRT-D ) .  The aim of this study was to investigate the impact of TM on clinical outcomes in a population of CRT-D patients with heart failure . METHODS In a multicentre , r and omised study , patients with chronic heart failure , New York Heart Association ( NYHA ) functional class II or III , left bundle branch block , severe left ventricle ejection fraction reduction ( LVEF < 35 % ) have been identified and screened . RESULTS One hundred and ninety-one patients have been r and omised to receive either a CRT-D with TM or a CRT-D with traditional ambulatory monitoring ( control group ) and completed the 12-month study follow-up . Primary endpoints were all cause death , cardiac death and hospital admission for heart failure . Secondary endpoints were atrial fibrillation , sustained episodes , non-sustained and self terminated ventricular tachyarrhythmia , sustained ventricular tachycardia , and ventricular fibrillation , ICD shocks and percentage of CRT-D responder patients . Univariate analysis identified the following factors predicting hospitalisation : TM , age , chronic kidney disease , hypercholesterolaemia , LVEF and NYHA class . At multivariate analysis , TM was the only factor predicting heart failure hospitalisation ( hazard ratio 0.6 , 0.42 - 0.79 , 95 % CI , p = 0.002 ) , without affecting overall mortality and cardiac deaths events . CONCLUSIONS Taken together , our data indicate the importance of TM in predicting heart failure hospitalisation in patients treated with BACKGROUND Exercise training ( ExT ) improves exercise capacity in chronic heart failure , but the results of home-based training have been variable . We sought the predictors of favorable outcome using a telemonitoring approach . METHODS Exercise capacity and quality of life ( QOL ) were assessed in 30 patients ( 28 men , age 64 + /- 8 years ) with symptomatic chronic heart failure and left ventricular ejection fraction < or = 35 % ( 28 % + /- 9 % ) undergoing 8 months of home ExT.  Patients were provided with heart rate monitors and exercise diaries after undergoing 4 months of hospital-based ExT. Weekly telephone contact was established and heart rate data were downloaded bimonthly . Changes in peak oxygen consumption per unit time ( V*O2 ) and QOL were compared between the 15 most and 15 least adherent patients defined by the number of hours per week at > 60 % maximum heart rate , observed during heart-rate monitoring . RESULTS Peak V*O2 increased by 26 % ( P < .001 ) after 4 months of hospital ExT , but this increase had fallen to 8 % ( P = .07 ) at 12 months ; only adherent patients ( n = 15 ) showed persistent improvement of peak V*O2 at 12 months ( P = .02 ) . Improvement in peak V*O2 at 12 months was associated with baseline peak V*O2 ( r = -0.61 , P < .001 ) and hours logged on the heart rate monitor ( r = 0.47 , P = .01 ) . Quality of life improvements were sustained at 12 months for the Minnesota Living with Heart Failure Question naire and Hare-Davis Depression Question naire . Nevertheless , QOL improvements achieved during the outpatient program were lost or attenuated at 12 months in nonadherent patients but were maintained in adherent patients . CONCLUSIONS Telemonitoring is feasible for following adherence to home ExT. Ongoing adherence is critical in obtaining sustained benefit from ExT in heart failure Background Most patients with heart failure are diagnosed and managed in primary care , however , underdiagnosis and undertreatment are common . We assessed whether implementation of a diagnostic-therapeutic strategy  improves functionality , health-related quality of life , and uptake of heart failure medication in primary care . Methods / Design A selective screening study followed by a single-blind cluster r and omized trial in primary care . The study population consists of patients aged 65 years or over who presented themselves to the general practitioner in the previous 12 months with shortness of breath on exertion . Patients already known with established heart failure , confirmed by echocardiography , are excluded . Diagnostic investigations include history taking , physical examination , electrocardiography , and serum N-terminal pro B-type natriuretic peptide levels . Only participants with an abnormal electrocardiogram or an N-terminal pro B-type natriuretic peptide level exceeding the exclusionary cutpoint for non-acute onset heart failure ( > 15 pmol/L ( ≈ 125 pg/ml ) ) will undergo open-access echocardiography . The diagnosis of heart failure ( with reduced or preserved ejection fraction ) is established by an expert panel consisting of two cardiologists and a general practitioner , according to the criteria of the European Society of Cardiology guidelines . Patients with newly established heart failure are allocated to either the ' care as usual ’ group or the ' intervention ’ group . R and omization is at the level of the general practitioner . In the intervention group general practitioners receive a single half-day training in heart failure management and the use of a structured up-titration scheme . All participants fill out quality of life question naires at baseline and after six months of follow-up . A six-minute walking test will be performed in patients with heart failure . Information on medication and hospitalization rates is extracted from the electronic medical files of the general practitioners . Discussion This study will provide information on the prevalence of unrecognized heart failure in elderly with shortness of breath on exertion , and the r and omized comparison will reveal whether management based on a half-day training of general practitioners in the practical application of an up-titration scheme results in improvements in functionality , health-related quality of life , and uptake of heart failure medication in heart failure patients compared to care as usual . Trial registration Clinical Trials.gov BACKGROUND New strategies are required to optimize care in increasing numbers of chronic heart failure patients . The aim of this r and omised trial was to evaluate a remote guidance system . METHODS Intervention group patients received a home TV-channel providing educational material s. Tele-guidance was performed by a Medical Service Centre . Control group patients were followed by cardiologists and HF-nurses . Primary endpoints were total days in hospital for all causes and days alive and out of hospital . Secondary endpoints were : quality of life and knowledge of disease and self care . RESULTS 214 patients were enrolled , median age was 66 years , 89 % had systolic LV dysfunction , and 90 % were in NYHA class II or III . The mean LVEF was 31 % . Over a mean follow-up duration of 288 days , there were 199 hospital admissions in 105 patients . Comparison of the groups revealed no differences for the primary outcomes or for QoL or self care behaviour . Knowledge about heart failure however , increased significantly more in the Intervention group ( p<0.001 ) . CONCLUSION Tele-guidance may play a role in the management of heart failure patients since it takes over some of the tasks of HF-nurses . This may facilitate delivery of optimal care to more patients with the same level of experienced staff Background Heart failure ( HF ) patients suffer from frequent and repeated hospitalizations , causing a substantial economic burden on society . Hospitalizations can be reduced considerably by better compliance with self-care . Home telemonitoring has the potential to boost patients ’ compliance with self-care , although the results are still contradictory . Objective A r and omized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization . Methods HF patients were eligible whose left ventricular ejection fraction was lower than 35 % , NYHA functional class ≥2 , and who needed regular follow-up . Patients in the telemonitoring group ( n=47 ) measured their body weight , blood pressure , and pulse and answered symptom-related questions on a weekly basis , reporting their values to the heart failure nurse using a mobile phone app . The heart failure nurse followed the status of patients weekly and if necessary contacted the patient . The primary outcome was the number of HF-related hospital days . Control patients ( n=47 ) received multidisciplinary treatment according to st and ard practice s. Patients ’ clinical status , use of health care re sources , adherence , and user experience from the patients ’ and the health care professionals ’ perspective were studied . Results Adherence , calculated as a proportion of weekly su bmi tted self- measurements , was close to 90 % . No difference was found in the number of HF-related hospital days ( incidence rate ratio [IRR]=0.812 , P=.351 ) , which was the primary outcome . The intervention group used more health care re sources : they paid an increased number of visits to the nurse ( IRR=1.73 , P<.001 ) , spent more time at the nurse reception ( mean difference of 48.7 minutes , P<.001 ) , and there was a greater number of telephone contacts between the nurse and intervention patients ( IRR=3.82 , P<.001 for nurse-induced contacts and IRR=1.63 , P=.049 for patient-induced contacts ) . There were no statistically significant differences in patients ’ clinical health status or in their self-care behavior . The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study . Conclusions Home telemonitoring did not reduce the number of patients ’ HF-related hospital days and did not improve the patients ’ clinical condition . Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently , and on this way increased the use of health care re sources . Trial Registration Clinical trials.gov NCT01759368 ; http:// clinical trials.gov/show/NCT01759368 ( Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z ) Background Heart failure is a prevalent health problem associated with costly hospital readmissions . Transitional care programs have been shown to reduce readmissions but are costly to implement . Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed . The objective of this r and omized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight , blood pressure , heart rate , and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure . Methods / Design A multi-center , r and omized controlled trial is being conducted at six academic health systems in California . A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure . Patients in the intervention group will receive intensive patient education using the ‘ teach-back ’ method and receive instruction in using the telemonitoring equipment . Following hospital discharge , they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a central ized call center . The nurses also will call patients and patients ’ physicians in response to alerts generated by the telemonitoring system , based on predetermined parameters . The primary outcome is readmission for any cause within 180 days . Secondary outcomes include 30-day readmission , mortality , hospital days , emergency department ( ED ) visits , hospital cost , and health-related quality of life . Discussion BEAT-HF is one of the largest r and omized controlled trials of telemonitoring in patients with heart failure , and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring . The study population also includes patients with a wide range of demographic and socioeconomic characteristics . Once completed , the study will be a rich re source of information on how best to use remote technology in the care management of patients with chronic heart failure . Trial registration Clinical Trials.gov # NCT01360203 Heart failure ( HF ) is the leading cause of rehospitalization in older adults . The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions , emergency department visits , costs , and risk of hospital readmission for patients with HF . One hundred two patient/caregiver dyads were r and omized into 2 groups postdischarge ; 84 dyads completed the study . Hospital readmissions , emergency department visits , costs , and days to readmission were abstract ed from medical records . Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms , quality of life , and caregiver mastery . There were no significant differences due to telemonitoring for any outcomes . Caregiver mastery , informal social support , and electronic home monitoring were not significant predictors for risk of hospital readmission . Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit
St and ardised description of the telemonitoring algorithm can expedite the identification of key components in telemonitoring algorithms that allow accurate prediction of worsening heart failure
Introduction : Non-invasive telemonitoring programmes detecting deterioration of heart failure are increasingly used in heart failure care .
Aim : The aim of this study was to compare different monitoring algorithms used in non-invasive telemonitoring programmes for patients with chronic heart failure .