Remote patient monitoring does not reduce readmissions or mortality for heart failure patients

An intervention for patients hospitalized for heart failure that included health coaching telephone calls and remote patient telemonitoring did not reduce 180-day readmissions for any cause or 180-day mortality, according to a prospective, multicenter, randomized trial.

Lead researcher Michael K. Ong, MD, PhD, of the University of California, Los Angeles, and colleagues published their results online in JAMA Internal Medicine on Feb. 8.

In this study, called BEAT-HF (Better Effectiveness After Transition – Heart Failure), the researchers randomized 1,437 adults who were hospitalized for decompensated heart failure between Oct. 12, 2011, and Sept. 30, 2013, and then discharged home.

The study was conducted at six academic medical centers, including Cedars-Sinai Medical Center in Los Angeles and the University of California sites in Davis, Irvine, Los Angeles, San Diego and San Francisco.

Patients were eligible if they were at least 50 years old, receiving treatment for decompensated heart failure, expected to be discharged to their home and capable of providing written informed consent in English, Spanish, Farsi or Russian.

The median age of participants was 73, while 46.2 percent were female and 22 percent were African Americans.

For patients randomized to the intervention group, registered nurses provided them with predischarge heart failure education, regularly scheduled telephone coaching and home telemonitoring of weight, blood pressure, heart rate and symptoms. During a six-month period, the patients were scheduled to receive nine telephone coaching calls from a call center nurse who had access to their medical histories and medication records.

Patients in the usual care group received extensive postdischarge education and a follow-up telephone call. They did not have any other required interventions, although they could have additional surveillance if medical personnel deemed it necessary.

Of the 715 adults randomized to the intervention group, 82.7 percent used the telemonitoring equipment, which the researchers said consisted of a wireless transmission pod, a weight scale and a blood pressure and heart rate monitor integrated with a device that could display text questions and send simple text responses. The adherence rates to telemonitoring were 55.4 percent of total days at 30 days and 51.7 percent of total days at 180 days. The adherence rates to telephone coaching were 61.4 percent of total telephone calls at 30 days and 68 percent of total telephone calls at 180 days.

Within 180 days of hospital discharge, 50 percent of patients were readmitted for any cause, including 50.8 percent of patients in the intervention group and 49.2 percent of patients in the usual care group. The researchers noted that subgroup analyses found there were no significant differences in readmissions for patients based on their age, sex, race/ethnicity or New York Heart Association classification.

The 30-day all-cause readmission rate was 22.7 percent, including 22.7 percent for intervention group patients and 21.6 percent for usual care patients. The 30-day all-cause mortality rate was 4.4 percent, including 3.4 percent and 5.4 percent, respectively. Meanwhile, the 180-day all-cause mortality rate was 14.9 percent, including 14 percent and 15.8 percent, respectively.

The researchers mentioned that the intervention group had a significantly better 180-day quality-of-life scores compared with the usual care group.

They added that the study had a few limitations, including that they did not extend enrollment beyond Sept. 30, 2013, because they relied mostly on funding from the American Recovery and Reinvestment Act of 2009. They also noted that the results may not be generalizable because they only enrolled patients at academic medical centers in California and they only used registered nurses for the intervention.