Nurse-Led Collaborative Management Using Telemonitoring Improves Quality of Life and Prevention of Rehospitalization in Patients with Heart Failure

Abstract

The effects of disease management using telemonitoring for patients with heart failure (HF) remain controversial. Hence, we embedded care coordination and enhanced collaborative self-management through interactive communication via a telemonitoring system (collaborative management; CM). This study evaluated whether CM improved psychosocial status and prevented rehospitalization in patients with HF in comparison with selfmanagement education (SM), and usual care (UC). We randomly allocated 59 patients into 3 groups; UC (n = 19), SM (n = 20), and CM (n = 20). The UC group received one patient education session, and the SM and CM groups participated in disease management programs for 12 months. The CM group received telemonitoring concurrently. All groups were followed up for another 12 months. Data were collected at baseline and at 6, 12, 18, and 24 months. The primary endpoint was quality of life (QOL). Secondary endpoints included self-efficacy, self-care, and incidence of rehospitalization. The QOL score improved in CM compared to UC at 18 and 24 months (P < 0.05). There were no significant differences among the 3 groups in self-efficacy and self-care. However, compared within each group, only the CM had significant changes in self-efficacy and in self-care (P < 0.01). Rehospitalization rates were high in the UC (11/19; 57.9%) compared with the SM (5/20; 27.8%) and CM groups (4/20; 20.0%). The readmission-free survival rate differed significantly between the CM and UC groups (P = 0.020). We conclude that CM has the potential to improve psychosocial status in patients with HF and prevent rehospitalization due to HF.

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Ōsakikamijima, Japan

“…We have developed various nurse-led disease management programs at community-based and collaborating with primary care physicians. [13][14][15][16] We assumed by combining this method with telenursing, it was possible to provide support to encourage SM education to prevent the onset and exacerbation of cardiometabolic risks among residents, even in remote islands with limited medical resources.…”

Influential Factors in Remote Monitoring of Heart Failure Patients: A Review of the Literature and Direction for Future Research

“…Daily weight was electronically transmitted in the intervention group in [ 29 ] where the all-cause mortality and HF hospitalization hazard ratios were 0.57 and 0.9, respectively. In addition, in [ 78 ], there was a significant improvement in the intervention group compared to the usual group, where patients used telemonitoring devices to monitor BP, weight and HR over 12 months, achieving a hazard ratio for HF hospitalization of 0.29, which can be seen in Figure 9 b. This figure also shows that in [ 48 ], patients with a positive combined HF device diagnostic have a 4.8-fold increase of HF hospitalization after adjusting for clinical variables.…”

“…Therefore, implementing mechanisms that both monitor and encourage daily measurement along with staff enthusiasm toward using the system can help improve adherence. In another study, the nurse-led collaborative management group showed promising results with reductions in readmission rates and improved quality of life compared to usual care [ 78 ]. They suggest the effectiveness of this telemonitoring study was due to the collaborative support by nurses and healthcare workers rather than simply concentrating on physiological parameters.…”

Effectiveness of a Telenursing System to Prevent the Exacerbation of Symptoms in Patients with Cancer Undergoing Outpatient Chemotherapy

“…The results of a meta-analysis of diabetic patients were showed that the use of telenursing (vs. usual care) was associated with a significant reduction in HbA1c levels compared to usual care [12]. Similarly, tele-nursing for patients with heart failure was shown to be effective in improving the QOL of patients, preventing readmission, and improving cost effectiveness [13] [14].…”