Effect of home-based telecardiology on chronic heart failure: Costs and outcomes

Abstract

Chronic heart failure (CHF) remains a common cause of disability. We have investigated the use of home-based telecardiology (HBT) in CHF patients. Four hundred and twenty-six patients were enrolled in the study: 230 in the HBT group and 196 in the usual-care group. HBT consisted of trans-telephonic follow-up and electrocardiogram (ECG) monitoring, followed by visits from the paramedical and medical team. A one-lead ECG recording was transmitted to a receiving station, where a nurse was available for reporting and interactive teleconsultation. The patient could call the centre when assistance was required (tele-assistance), while the team could call the patient for scheduled appointments (telemonitoring). The one-year clinical outcomes showed that there was a significant reduction in rehospitalizations in the HBT group compared with the usual-care group (24% versus 34%, respectively). There was an increase in quality of life in the HBT group (mean Minnesota Living Questionnaire scores 29 and 23.5, respectively). The total costs were lower in the HBT group (107,494 and 140,874, respectively). The results suggest that a telecardiology service can detect and prevent clinical instability, reduce rehospitalization and lower the cost of managing CHF patients.

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission

“…[6][7][8][9][10][11][12][13][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Twenty-one studies applied to general populations, largely older adults and together included 10 445 patients. 1,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] Four studies applied to unique populations.…”

Clinical and Psycological Telemonitoring and Telecare of High Risk Patientswith Chronic Heart Failure through Wireless Technologies: The Icaros Project

“…Thus, it is mandatory to build a a completely new standard of assistance, involving a strict cooperation and information exchange among heart failure specialists, dedicated nurses and general practitioners: indeed, a patient should be followed, according to his/her clinical status, by anyone of these caregivers in different times [39]. A network of telenursing for patients with hert failure could help the General Practioner, allowing his/her regular exchange of clinical information and consulting with the Heart Failure Center [25,26]: an experience of this kind is currently ongoing in many Italian regions, and among them is Lombardia. We have already suggested that a Telemonitoring similar to the ICAROS model could take place in a first phase, soon after hospital discharge when patients are more fragile [27].…”

“…After TEMISTOCLE, a network for the integrated management of patients with chronic, stable heart failure has been developed in Italy, with favorable preliminary results [23][24][25][26]. To fill the gap between these models of home-based care for stable patients, and the hospital-based care for acute and sicker patients, we designed the ICAROS project (Integrated care vs Conventional intervention in cArdiac failure patients: Randomized Open label Study), in which the clinical approach of heart failure specialists was integrated with Internet and wireless technologies with the aim of developing a decision-making model that could fit the needs of fragile patients [27].…”

Design Requirements for a Patient Administered Personal Electronic Health Record

“…However, the platform used was not integrated into the patients EHR system. A clear outcome effects of a home-based tele-cardiology service has been verified by Scalvini et al (2005), where the patients' ECG recordings automatically were transmitted to a receiving station available for trained nurses (telemonitoring), also this solution was a stand-alone receiving database. In a report on remote monitoring, the U.S. Department of Health and Human Services has described use cases to define possible solutions for information exchange and integration of patient-monitored data into a national health information technology (U.S. Dept of Health and Human Services (2008).…”