A multidisciplinary telehealth program in patients with combined chronic obstructive pulmonary disease and chronic heart failure: study protocol for a randomized controlled trial Impact of Telehealth on Clinical Outcomes in Patients With Heart Failure Managing heart failure patients after formal homecare. Home-based telehealth hospitalization for exacerbation of chronic obstructive pulmonary disease: findings from "the virtual hospital" trial. The hospital course and short term prognosis of patients presenting to the emergency room with decompensated congestive heart failure. Telecardiology for patients with chronic heart failure: the 'SHL' experience in Israel. Association of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Rationale and design of the EMPERIAL‐Preserved and EMPERIAL‐Reduced trials of empagliflozin in patients with chronic heart failure Clinical characteristics and long-term outcome of patients in whom congestive heart failure develops after thrombolytic therapy for acute myocardial infarction: development of a predictive model. Effects of short-term exercise training in patients with heart failure. Home telecare for COPD/CHF patients: outcomes and perceptions A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial Continuous hemodynamic monitoring in patients with mild to moderate heart failure: results of The Reducing Decompensation Events Utilizing Intracardiac Pressures in Patients With Chronic Heart Failure (REDUCEhf) trial. Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Effects of tolvaptan on physician-assessed symptoms and signs in patients hospitalized with acute heart failure syndromes: analysis from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) trials. 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
Background Chronic obstructive pulmonary disease ( COPD ) and chronic heart failure ( CHF ) frequently coexist , significantly reducing patients ’ quality of life and increasing morbidity and mortality . For either single disease , a multidisciplinary disease-management approach supported by telecommunication technologies offers the best outcome in terms of prolonged survival and reduced hospital readmissions . However , no data exist in patients with combined COPD /CHF.We planned a r and omized controlled trial to investigate the feasibility and efficacy of an integrated , home-based , medical/nursing intervention plus a rehabilitation program versus conventional care in patients with coexisting COPD /CHF . The purpose of the paper is to describe the rationale and design of the trial . Methods / design s Patients , after inpatient rehabilitation , were r and omly assigned to the intervention or control group , followed for 4 months at home , then assessed at 4 and 6 months . The intervention group followed a telesurveillance ( telephone contacts by nurse and remote monitoring of cardiorespiratory parameters ) and home-based rehabilitation program ( at least three sessions/week of mini-ergometer exercises , callisthenic exercises and twice weekly pedometer-driven walking , plus telephone contacts by a physiotherapist ) . Telephone follow-up served to verify compliance to therapy , maintain exercise motivation , educate for early recognition of signs/symptoms , and verify the skills acquired . At baseline and 4 and 6 months , the 6-min Walk Test , dyspnea and fatigue at rest , oxygenation ( PaO2/FiO2 ) , physical activity profile ( PASE question naire ) , and QoL ( Minnesota and CAT question naires ) were assessed . During the study , serious clinical events ( hospitalizations or deaths ) were recorded . Discussion Currently , no studies have assessed the impact of a telehealth program in patients with combined COPD and CHF . Our study will show whether this approach is effective in the management of such complex , frail patients who are at very high risk of exacerbations . Trial registration Network per la prevenzione e la sanità pubblica , CCM , Ministero della Salute “ Modelli innovativi di gestione integrata telegestita ospedale-territorio del malato cronico a fenotipo complesso : studio di implementazione , validazione e impatto , ” registered on 14 January 2014 . Clinical Trials.gov Identifier : NCT02269618 , registered on 17 October 2014 The purpose of this r and omized field study was to determine the effects of telehomecare on hospitalization , emergency department ( ED ) use , mortality , and symptoms related to sodium and fluid intake , medication use , and physical activity . The sample consists of 284 patients with heart failure . The authors used logistic regression to study the effects of telehomecare on health services utilization and mortality and a general linear model to analyze changes in self-reported symptoms . On average , patients in the telehomecare groups had a lower probability of hospitalizations and ED visits than did patients in the control group . Differences were statistically significant at 60 days but not 120 days . Results show a greater reduction in symptoms for patients using telehomecare compared to control patients . The technology enables frequent monitoring of clinical indices and permits the home health care nurse to detect changes in cardiac status and intervene when necessary The aim of this study was to determine whether using a teleheath system after discharge from formal home health services would improve clinical outcomes and self-management behaviors .  Patients were recruited from 10 home health agencies ( HHAs ) across the United States . All patients used the Health Buddy telehealth system  during formal home health services . Patients were r and omly assigned to either the telehealth group or the control group  upon discharge from the HHA . Patients in the telehealth group used the Health Buddy for an additional 180 days ; patients in the control group received no further telehealth or home health services . Results show that patients who continued using telehealth beyond the formal episode of care showed greater improvements in respiratory status and activities of daily living . None of the patients who used telehealth during this stage had any hospitalizations or Emergency Department ( ED ) events , while 28.3 % of the control group patients required hospitalization and 26.1 % had at least one ED visit . Telehealth patients were more likely to report that they measured their weights daily , and were more likely to report an increase in diuretic dose following sudden weight gain , ankle swelling , or shortness of breath . We conclude that patients with heart failure may benefit from continued use of telehealth following formal home health services . Results of this study will inform managers and clinicians who are responsible for integrating telehealth into chronic disease protocol BACKGROUND Telehealth interventions for patients with chronic obstructive pulmonary disease ( COPD ) have focused primarily on stable out patients .  Telehealth design ed to h and le the acute exacerbation that normally requires hospitalization could also be of interest . The aim of this study was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD . MATERIAL S AND METHODS A two-center , noninferiority , r and omized , controlled effectiveness trial was conducted between June 2010 and December 2011 . Patients with severe COPD admitted because of exacerbation were r and omized 1:1 either to home-based telehealth hospitalization or to continue st and ard treatment and care  at the hospital . The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge . The noninferiority margin was set at 20 % of the control group 's risk of re-admission . Secondary outcomes were mortality , need for manual or mechanical ventilation or noninvasive ventilation , length of hospitalization , physiological parameters , health-related quality of life , user satisfaction , healthcare costs , and adverse events . RESULTS In total , 57 patients were r and omized : 29 participants in the  telehealth group and 28 participants in the control group . Testing the incidence of re-admission within 30 days after discharge could not confirm noninferiority ( lower 95 % confidence limit [ CL ] , -24.8 % ; p=0.35 ) . Results were also nonsignificant at 90 days ( lower 95 % CL , -16.2 % ; p=0.33 ) and 180 days ( lower 95 % CL , -16.6 % ; p = 0.33 ) after discharge . Superiority testing on secondary outcomes showed nonsignificant differences between groups . Healthcare costs have not yet been evaluated . CONCLUSIONS Whether home-based telehealth hospitalization is noninferior to conventional hospitalization requires further investigation . The results indicate that a subgroup of patients with severe COPD can be treated for acute exacerbation at home using telehealth , without the physical presence of health professionals and with a proper organizational " back-up . OBJECTIVES This observational study was done to describe the characteristics , hospital course and short term prognosis of patients presenting to an emergency room with decompensated heart failure and to determine the parameters influencing the length of their hospital stay . DESIGN The routine clinical and laboratory characteristics of consecutive patients presenting to an emergency room with decompensated heart failure were documented and the patients followed for six months . SETTING One teaching hospital and one community-based hospital in Montreal , Quebec . PATIENTS A prospect i ve cohort of 153 consecutive patients presenting to the emergency room with decompensated heart failure . Follow-up was by clinic visit and telephone survey at one , three and six months . Follow-up was 100 % . MEASURES OF OUTCOME Length of hospital stay , in-hospital mortality , readmissions and after hospital discharge deaths were measured . RESULTS The average length of hospital stay was 6.2 days with a skewed distribution ranging from one to 56 days . A multivariate analysis showed that the length of hospital stay was associated with increasing left atrial size ( P < 0.05 ) , an ischemic etiology of the heart failure ( P < 0.03 ) and a slow response to diuretic therapy ( P < 0.001 ) . This mathematical model accounted for only a small amount of hospital stay variability ( R2 = 0.22 ) . Six month mortality and morbidity of these patients was high , with 23 % dying and 30 % readmitted for heart failure , but was independent of the duration of the initial hospitalization . CONCLUSIONS This prospect i ve study confirms that the hospital course for congestive heart failure is shortening . The six month prognosis of patients presenting to an emergency room for decompensated heart failure is poor and appears independent of the length of hospital stay BACKGROUND Patients with chronic heart failure characteristically have multiple hospital admissions for symptom control , deleteriously affecting their quality of life and imposing a burden on national healthcare costs . We assessed the effect of a novel transtelephonic monitoring and follow-up program on the admission rate and length of hospital stay as well as changes in their subjectively rated quality of life of patients with chronic heart failure . METHODS This prospect i ve 1-year study was conducted on compliant subscribers to ' SHL ' , a telecardiological service with > 60,000 subscribers , who were admitted > or = 2 times during the previous year for recurrent pulmonary edema or deterioration in heart failure . Their heart rate , blood pressure and body weight measurements were now automatically transmitted daily to ' SHL"s data bank and added to stored and up date d medical records . A question naire survey acquired information on their quality of life . RESULTS The study cohort included 118 patients , mean age 75 years ( range 49 - 89 years ) , 65 % males , a II-IV class functional capacity and a 25 % ( range 10 - 39 % ) mean ejection fraction . There was a 66 % reduction in the total hospitalization days ( from 1623 in the year preceding study entry to 558 during the study period , p<0.0001 ) . Although only 38/118 patients were hospitalized , most participants reported a significant subjective improvement in their quality of life . CONCLUSIONS Data are provided to demonstrate that a transtelephonic system allowing primary care at the patient 's home can significantly reduce hospitalization rate and length of stay and significantly enhance the quality of life of patients with chronic heart failure Patients admitted with heart failure have disproportionately high readmission rates , most recently ranging from 17.5 % to 30.3 % nationally.1 The Affordable Care Act penalizes hospitals with higher than average readmission rates after admissions for heart failure . However , clinicians remain uncertain , which strategies are associated with reducing readmissions in this population .2 Experts have proposed that the creation and transmission of a high- quality discharge summary to outpatient clinicians may improve the transition from hospital to home . Discharge summaries may facilitate safer transitions in care by informing outpatient clinicians about the course of hospitalization , identifying pending studies requiring follow-up , suggesting further follow-up testing , and clarifying changes in medications and treatments after discharge . Nonetheless , despite widespread enthusiasm for improving the quality of discharge summaries , there have been few studies of the effectiveness of discharge summaries in helping to avoid readmissions , and those few have found no association of timeliness,3,4 transmission,5,6 or content5 with readmission . To determine the association of discharge quality and readmission in a large national sample , we examined discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes ( Tele-HF ) r and omized controlled trial . # # # Study Cohort and Setting The  Tele-HF study included patients living at home and hospitalized for heart failure in the previous 30 days.7 Patients in Tele-HF were recruited from 33 cardiology practice s in 21 states and the District of Columbia . We obtained discharge summaries for the index hospitalization . Wherever possible , we obtained PURPOSE Telehealth care is emerging as a viable intervention model to treat complex chronic conditions , such as heart failure ( HF ) and chronic obstructive pulmonary disease ( COPD ) , and to engage older adults in self-care disease management . DESIGN AND METHODS We report on a r and omized controlled trial examining the impact of a multifaceted telehealth intervention on health , mental health , and service utilization outcomes among homebound medically ill older adults diagnosed with HF or COPD . R and om effects regression modeling was used , and we hypothesized that older adults in the telehealth intervention ( n = 51 ) would receive significantly better quality of care result ing in improved scores in health-related quality of life , mental health , and satisfaction with care at 3 months follow-up as compared with controls ( n = 51 ) and service utilization outcomes at 12 months follow-up . RESULTS At follow-up , the telehealth intervention group reported greater increases in general health and social functioning , and improved in depression symptom scores as compared with usual care plus education group . The control group had significantly more visits to the emergency department than the telehealth group . There was an observed trend toward fewer hospital days for telehealth participants , but it did not reach significance at 12 months . IMPLICATION S Telehealth may be an efficient and effective method of systematic ally delivering integrated care in the home health sector . The use of telehealth technology may benefit homebound older adults who have difficulty accessing care due to disability , transportation , or isolation Aims Heart failure ( HF ) is associated with considerable symptom burden and impairment in physical functioning and quality of life . The sodium – glucose co‐transporter 2 inhibitor empagliflozin reduced the risk of HF hospitalisation and cardiovascular death in patients with type 2 diabetes and established cardiovascular disease in the EMPA‐REG OUTCOME trial , and could potentially improve congestion symptoms and exercise capacity in patients with HF . We describe the design s of the EMPERIAL‐Preserved and EMPERIAL‐Reduced trials of empagliflozin in patients with chronic stable HF , with or without type 2 diabetes . Methods EMPERIAL‐Preserved and EMPERIAL‐Reduced are r and omised , placebo‐controlled trials design ed to investigate the effects of empagliflozin on exercise capacity and patient‐reported outcomes in patients with chronic stable HF with preserved ejection fraction [ HFpEF ; left ventricular ejection fraction ( LVEF ) > 40 % ] and HF with reduced ejection fraction ( HFrEF ; LVEF ≤ 40 % ) , respectively . In each trial , approximately 300 patients will be r and omised 1:1 to receive empagliflozin  10 mg  or placebo  once daily for 12 weeks . In both trials , the primary endpoint is the change from baseline in 6‐min walk test distance at week 12 . Key secondary endpoints are the change from baseline in Kansas City Cardiomyopathy Question naire total symptom score and change from baseline in dyspnoea score of the Chronic Heart Failure Question naire at week 12 . Conclusion The EMPERIAL‐Preserved and EMPERIAL‐Reduced trials will determine the effects of empagliflozin on exercise capacity and patient‐reported outcomes in patients with HFpEF and HFrEF , respectively , and provide insight into the potential of empagliflozin in the treatment of patients with HF . Clinical Trial Registration : Clinical Trials.gov ID : NCT03448406 ( EMPERIAL‐Preserved ) , NCT03448419 ( EMPERIAL‐Reduced ) Ischemic heart disease is the most common cause of congestive heart failure , which often begins after acute myocardial infa rct ion . To better delineate the clinical characteristics and outcomes of patients in whom congestive heart failure develops after acute myocardial infa rct ion in the thrombolytic era , we prospect ively evaluated patients enrolled in six of the TAMI trials . The study cohort comprised 1619 consecutive patients who had at least 1 mm of ST-segment elevation in two contiguous electrocardiographic leads within 6 hours of the onset of acute myocardial infa rct ion and who received intravenous thrombolytic therapy .  We prospect ively collected clinical characteristics , baseline demographics , acute and 1-week angiographic variables , and in-hospital and 1-year outcome data . We performed stepwise multivariable regression analysis to determine the noninvasive and invasive predictors of the development of in-hospital congestive heart failure . Congestive heart failure  developed in 301 patients in the hospital ( 19 % of 1521 patients admitted were not in heart failure ) . These patients were likely to be older and female , have diabetes mellitus and previous myocardial infa rct ion , and have an anterior wall myocardial infa rct ion . On acute angiography , they had lower ejection fractions and a higher incidence of multivessel disease . Patency at 90 minutes was lower in the patients with congestive heart failure , and acute mitral regurgitation occurred in 1.6 % versus 0.21 % of patients without congestive heart failure . Patients with congestive heart failure had higher mortality , more in-hospital complications , and longer hospitalizations . At 1-year follow up , 21 % of the patients in whom congestive heart failure developed had died versus 5 % in the group without congestive heart failure . Predictors of new congestive heart failure included increased age , anterior wall myocardial infa rct ion , lower pulse pressure and systolic blood pressure , diabetes mellitus , and the presence of rales on admission . The acute angiographic variables of reduced ejection fraction , increased number of diseased vessels , and attempted percutaneous intervention improved the concordance of the predictive model by 6 % . Congestive heart failure remains a common clinical problem after acute myocardial infa rct ion and is associated with a twofold increase in in-hospital morbidity and a fourfold increase in in-hospital and 1-year mortality . The development of congestive heart failure in the hospital can be predicted from noninvasive and invasive baseline characteristics . We present a simple table to predict congestive heart failure from baseline characteristics and invasive information Heart failure is a debilitating disorder which limits exercise capacity and produces a poor quality of life . The present study was design ed to determine the effects of an exercise training program on patients with CHF NYHA functional class II-III , attributed to left ventricular systolic dysfunction and dilated left ventricle . Twenty-two ambulatory male patients with stable CHF were r and omised to a training ( n = 15 ) and a control group ( n = 7 ) . A symptom limited ramp cardiopulmonary exercise test with gas exchange analysis was performed at baseline after 4 and 8 weeks . The training group underwent an exercise training program at 50 % of peak oxygen uptake for eight weeks . The control group was not exercised . After 8 weeks , compared with baseline , there were statistically significant increase in peak oxygen uptake , peak workload , anaerobic threshold , oxygen pulse , RPP , ventilation and the duration of the test only in trained patients . The reduction in scores tested by the Minnesota Living with Heart Failure question naire ( p < 0.001 ) and Borg dyspnea rating score ( p < 0.001 ) reflect the reduction of symptoms and the improvement in health-related quality of life .  Carefully selected patients with moderate to severe CHF can achieve significant improvements of exercise capacity and quality of life with exercise training and can safely participate in a conditioning program We evaluated the use of home telehealth for patients with chronic obstructive pulmonary disease ( COPD ) and /or congestive heart failure ( CHF ) . Patients diagnosed with COPD and /or CHF who were prescribed home health-care services were r and omly assigned to an experimental group where they received home health care through a combination of traditional face-to-face and telemedicine visits  ( n = 83 ) , and a  control group  where only conventional home care was employed  ( n = 78 ) . Data were collected via the Short Form 36 ( SF-36 ) , Outcome and Assessment Information Set ( OASIS ) and patient charts . In the experimental group , patient perceptions of the home telecare services were collected via telephone interviews . Overall , the addition of telehealth to COPD /CHF patient care was not a significant predictor of health and wellbeing , either positively or negatively . Although those receiving telehealth had worse ratings on the SF-36 general health subscale after the intervention , this measure was only significant when controlling for a number of key variables in the model . In regard to patient perceptions of home telecare , patients were satisfied with the technology and the way that care was delivered via this modality Hospitalization for worsening chronic heart failure results in high post-discharge mortality , morbidity , and cost . However , thorough characterization , soon after discharge of patients with early post-discharge events has not been previously performed . The objectives of this study were to describe the baseline , in-hospital , and post-discharge clinical , laboratory , and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction ( EF ) who die or are re-admitted for cardiovascular ( CV ) causes within 90 days of initial hospitalization . Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF ≤40 % in the Efficacy of Vasopressin Antagonism in Heart Failure : Outcome Study with Tolvaptan ( EVEREST ) trial , which r and omized patients to tolvaptan or placebo , both in addition to st and ard therapy . Clinical and laboratory parameters were obtained within 48 h of admission , during hospitalization , and post-discharge weeks 1 , 4 , 8 , and every 8 weeks thereafter for a median of 9.9 months . Patients with events within 90 days were compared with those with later/no events . All-cause mortality ( ACM ) and CV re-hospitalization were independently adjudicated . Within 90 days of admission , 395 patients ( 9.6 % ) died and 801 patients ( 19.4 % ) were re-hospitalized for CV causes . Significant baseline and longitudinal differences were seen between groups with early versus later ( > 90 days ) or no events at 12 months post-r and omization . Post-discharge outcomes were similar in the tolvaptan and placebo groups . Patients with early post-discharge events experienced clinical ly significant worsening in signs and symptoms , laboratory values , and neurohormonal parameters soon after discharge . Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization Clinical trial results support the hypothesis that implantable hemodynamic monitoring ( IHM ) systems may reduce hospitalizations among patients with chronic heart failure ( HF ) . The Reducing Decompensation Events Utilizing Intracardiac Pressures in Patients With Chronic Heart Failure ( REDUCE hf ) study was a prospect i ve , r and omized , multicenter , single-blinded trial that enrolled patients with New York Heart Association class II or III symptoms , an indication for an implantable cardioverter-defibrillator ( ICD ) , and a previous HF hospitalization . A combination IHM-ICD was implanted and patients were r and omly assigned to a treatment group in which hemodynamic information was used or a control group in which hemodynamic information was not available . Patients were followed for 12 months to evaluate the primary efficacy end point of HF hospitalizations , emergency department visits , or urgent clinic visits . The trial was design ed to enroll 1300 patients , but stopped at 400 patients because of IHM lead failures experienced from previous trials . A total of 202 treatment patients and 198 controls were r and omized for 12-month follow-up . The primary safety end point was met , but the rate of HF equivalents was not different between groups . REDUCE hf was unable to test clinical efficacy end points adequately . The device combining IHM-ICD technology was safe and functioned appropriately . Patients at high risk for decompensated HF have high baseline filling pressures and demonstrate consistent increases as the process of congestion worsens to the time of hospitalization We evaluated a structured pharmaceutical care program for elderly patients ( > 65 yrs ) with congestive heart failure ( CHF ) based on objective measures of disease control , quality of life , and use of health care facilities in a r and omized , controlled , longitudinal , prospect i ve clinical trial . The 42 patients in group A received education from a pharmacist on the disease and its treatment , and lifestyle changes that could help control symptoms . Patients also were encouraged to monitor their symptoms and comply with prescribed drug therapy . If necessary , dosage regimens were simplified in liaison with hospital physicians . The 41 control patients ( group B ) received st and ard care . The following outcome measures were assessed in all patients at baseline ( before the start of the trial ) and at 3 , 6 , 9 , and 12 months : 2-minute walk test , blood pressure , body weight , pulse , forced vital capacity , quality of life [ disease-specific ( Minnesota Living with Heart Failure question naire ) and generic ( SF-36 ) ] , knowledge of symptoms and drugs , compliance with therapy , and use of health care facilities ( hospital admissions , visits to emergency room , emergency calls ) . Patients in group A showed improved compliance with drug therapy , which in turn improved their exercise capacity compared with those in group B ; education on management of symptoms , lifestyle changes , and dietary recommendations were also of benefit . Group A patients significantly improved knowledge of their drug therapy over the 12-month study and had fewer hospital admissions compared with group B patients . They also had improved outcomes compared with group B , despite the small sample s. An extension of this trial to other sites with pooling of results would provide additional evidence of the value of this structured program in elderly patients with CHF BACKGROUND A rapid and sustained relief of heart failure ( HF ) symptoms and signs is an important goal of management in patients hospitalized for acute HF syndromes ( AHFS ) . To date , no novel therapy in AHFS have been shown to improve signs and symptoms throughout hospitalization . This study explores the clinical effects of tolvaptan , a vasopressin-2-receptor antagonist , in addition to st and ard medical therapies on physician-assessed signs and symptoms in hospitalized AHFS patients . METHODS The EVEREST trial r and omized 4,133 patients admitted with worsening HF and reduced ejection fraction ( ≤ 40 % ) within 48 hours after hospital admission . On each inpatient day , investigators assessed dyspnea , orthopnea , fatigue , jugular venous distension ( JVD ) , rales , and pedal edema by predefined ordinal scales . Responder analyses were performed for each sign and symptom , with significant clinical response defined as a change in one point on the measurement scale . RESULTS Post hoc analysis demonstrated greater likelihood of clinical improvement in physician-assessed dyspnea , edema , orthopnea , and JVD among tolvaptan-treated subjects ( P < .05 ) as early as inpatient day 1 . This difference was observed throughout hospitalization only for JVD and orthopnea through day 3 . CONCLUSION The addition of tolvaptan to st and ard therapy for AHFS improves physician-assessed signs and symptoms during hospitalization without serious adverse short- or long-term effects 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
The effective management of patients with congestive heart failure in long term home care setting s is important in reducing rehospitalization , emergency department visits and improving quality of life .
Congestive heart failure results in clinical signs of edema , shortness of breath , and decreased quality of life .
Telehealth interventions following hospital discharge in various setting s have been reported in the published literature as having an impact on decreasing emergency department visits , rehospitalization and quality of life .