Impact of patient engagement in a French telemonitoring programme for heart failure on hospitalization and mortality

Abstract

Aims Management of patients with recently decompensated heart failure by hospital services is expensive, complicated to plan, and not always effective. Telemedicine programmes in heart failure may improve the quality of care, but their effectiveness is poorly documented in real‐world settings. The study aims to evaluate the impact of patient engagement in home‐based telemonitoring for heart failure (SCAD programme) on rehospitalization and mortality rates. Methods and results A retrospective observational study was performed in 659 SCAD participants. SCAD is a patient‐oriented service of home‐based interactive telemonitoring offered to heart failure patients during hospitalization who agree to participate in a therapeutic education programme. Patients were telemonitored for at least 3 months, and rehospitalization and mortality were documented at 12 months and 5 years. During the telemonitoring period, patients provided daily information on health and lifestyle through an internet‐based interface. Data were linked on a patient‐by‐patient basis between the SCAD database and the French national health insurance database (Système National des Données de Santé). Outcomes were compared as a function of use of the programme. Low, intermediate, and high users were classified by tercile of data return during telemonitoring. Patients were followed for a median of 32.9 months. Rehospitalization rates for cardiovascular disease decreased from 79.4% in the year preceding enrolment to 41.1% in the following year and from 52.8% to 18.8% for hospitalizations for heart failure. The 12 month mortality rate was 11.2%. Significant associations were observed between level of use of the SCAD programme and all‐cause rehospitalization (P = 0.0085), rehospitalization for cardiovascular disease (P = 0.0010), rehospitalization for heart failure (27.8% in low users, 12.9% in intermediate users, and 13.5% in high users; P < 0.0001), and mortality (26.8%, 15.2%, and 15.9% respectively; P = 0.0157) in the 12 months following enrolment. The mean number of days alive outside hospital were 279 ± 111 in low users, 312 ± 90 in intermediate users, and 304 ± 100 in high users (P = 0.0022). Conclusions Educational home telemonitoring of patients with heart failure following hospitalization provides long‐term clinical benefits in terms of rehospitalization and death in real‐world settings, according to the level of use of the programme by the patient. These benefits would be expected to have a major impact on the burden of this disease. Low engagement in telemonitoring could be used as a signal of poor prognosis and taken into account in the management strategy.

A telemonitoring programme in patients with heart failure in France: a cost-utility analysis

“…In addition, a secure chat tool is available for the patient throughout the duration of the programme which provides them with a direct contact with the care team and access to an information bank about heart failure. A full description of the organisation of the SCAD programme has recently been published [ 19 ].…”

“…Patients entered the model in one of three ‘not hospitalised’ health states, depending on the number of previous hospitalisations for HF, namely no previous hospitalisation for HF in the previous year, a single previous hospitalisation for HF, or multiple previous hospitalisations. The distribution of patients across these three health states was determined from the number of hospitalisations documented in the SNDS with HF as a primary diagnosis (identifying the reason for hospitalisation) in a population of patients with chronic HF enrolled into the SCAD telemonitoring programme in France between 2009 and 2016 [ 19 ]. Hospitalisations for HF were identified using the diagnostic algorithm developed by Tuppin et al [ 23 ].…”

“…The French health authorities are currently assessing the value of introducing a fully reimbursed telemonitoring programme at the national level for routine management of patients with HF. One of the candidate programmes for extension nationwide is the SCAD ( Suivi Clinique A Domicile ) programme, a home-based interactive telemonitoring service for HF established in the French region of Normandy in 2007 [ 19 ]. The programme is offered to all patients hospitalised for an acute exacerbation of HF, who are entered into the programme prior to discharge.…”

“…Between 2007 and 2016, around 1000 patients in Normandy have been enrolled in the programme. The benefits of the SCAD programme in terms of reduced hospitalisations and mortality have been demonstrated both in a randomised clinical trial [ 20 ] and in a naturalistic setting [ 19 ]. In an analysis of the French national health insurance database ( Système national des données de santé ; SNDS), the rate of unplanned hospitalisations for a cardiovascular diagnosis was halved in SCAD participants compared to non-participants, the rate of unplanned hospitalisations for HF divided by three, and mortality reduced by around twenty percent [ 19 ].…”

“…The benefits of the SCAD programme in terms of reduced hospitalisations and mortality have been demonstrated both in a randomised clinical trial [ 20 ] and in a naturalistic setting [ 19 ]. In an analysis of the French national health insurance database ( Système national des données de santé ; SNDS), the rate of unplanned hospitalisations for a cardiovascular diagnosis was halved in SCAD participants compared to non-participants, the rate of unplanned hospitalisations for HF divided by three, and mortality reduced by around twenty percent [ 19 ]. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD home telemonitoring programme with respect to standard hospital-based care in patients with HF in France.…”