Telemedicine Facilitates CHF Home Health Care for Those with Systolic Dysfunction

Abstract

An estimated 5 million Americans have congestive heart failure (CHF) and one in five over the age of 40 will develop CHF. There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management. A relatively new alternative for CHF outpatient care is telemedicine and e-health. We investigated the effects of a 6-week in-home telemedicine education and monitoring program for those with systolic dysfunction on the utilization of health care resources. We also measured the effects of the unit 4.5 months after its removal (a total of 6 months post introduction of the unit into the home). Concurrently, we assessed participants' perceptions of the value of having a telemedicine unit. Participants in the telemedicine group reported weighing more times a week with less variability than did the control group. Telemedicine led to a reduction in physician and emergency department visits and those in the experimental group reported the unit facilitating self-care, though this was not significantly different from the control group (possibly due to small sample size). These findings suggest a possibility for improvement in control of CHF when telemedicine is implemented. Our review of the literature also supports the role of telemedicine in facilitating home health care and self-management for CHF patients. There are many challenges still to be addressed before this potential can be reached and further research is needed to identify opportunities in telemedicine.

A systematic Review of the Mediating Role of Knowledge, Self-efficacy and Self-care Behaviour in Telehealth Patients with Heart Failure

“…non-significant) results on sub-scales of the measure used to assess self-care 33 and failing to report significance tests for some or all findings. 30,35 Three further studies 5, 31,36 failed to find any significant improvements in self-care behaviour for TH relative to alternative treatment or control groups. These studies tested various forms of TH Relationship between telehealth and self-efficacy Six studies assessed the effect of TH on self-efficacy or confidence relating to the performance of self-care -behaviours.…”

Value of Telemonitoring and Telemedicine in Heart Failure Management

“…15,16 However, the heavy economic costs related to the systematic organisation of patient follow-ups after hospital discharge have pushed the development of remote monitoring systems for the continuous control of clinical variables, such as blood pressure, oxygen saturation, heart rate, electrocardiogram and intracardiac/pulmonary pressure. The implementation of these monitoring tools has been hypothesised to augment medical control over the unstable syndrome of HF in order to prevent decompensations and to concurrently gain time and resources when compared to traditional care.…”

“…[28][29][30] The Randomised Trial of Telephone Intervention in Chronic Heart Failure (DIAL) study was one of the first trials investigating structured telephone support (STS) in 1,518 HF patients randomised to an STS intervention group or to a control "usual care" group. 15 In the intervention group, dedicated nurses phoned patients every 14 days and adjusted the frequency accordingly thereafter for a year. Predetermined standardised questions were used to assess dyspnea/fatigue, daily weight monitoring, oedema progression, dietary/drug compliance and physical activity.…”

Telemonitoring of Patients with Implantable Cardiac Devices to Manage Heart Failure: An Evaluation of Tablet-PC-Based Nursing Intervention Program

“…If early consultation can prevent aggravation of symptoms, participants will benefit. In some earlier studies [33]- [35], unplanned consultation was defined as one of the intervention outcome measures. Here, it seemed necessary to evaluate the intervention from different angles using multiple end points.…”