Telemonitoring of Heart Failure Patients and Their Caregivers: A Pilot Randomized Controlled Trial

Abstract

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.

A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes

“…In the main outcome papers of the complete studies only one paper reported null findings on all outcomes. (Schwarz et al, 2008) In the five papers which reported secondary outcomes or primary outcome variables at a later time null findings were noted. (Agren et al, 2013;Agren et al, 2015;Liljeroos et al, 2015Liljeroos et al, , 2016Liljeroos, Agren, Jaarsma, & Stromberg, 2014a) These included outcomes such as quality adjusted life years, (Agren et al, 2013) carer tasks, burden or patient morbidity, Liljeroos et al, 2016) or non-sustaining differences at a subsequent measurement time.…”

“…Countries where interventions were tested included the United States, (Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Piamjariyakul et al, 2015;Piette et al, 2008;Piette et al, 2015) Sweden, (Ågren et al, 2015;Agren et al, 2012) New Zealand, (Kenealy et al, 2015) Iran, (Hasanpour-Dehkordi et al, 2016) and Thailand. (Srisuk et al, 2015) Settings where the intervention was initiated or where the majority of the interventions were delivered included hospitals, (Agren et al, 2012;Bull et al, 2000;Hasanpour-Dehkordi et al, 2016;Kenealy et al, 2015;Piette et al, 2008;Schwarz et al, 2008) clinics, (Ågren et al, 2015;Agren et al, 2012;Dunbar et al, 2013;Piamjariyakul et al, 2015;Srisuk et al, 2015) home, (Agren et al, 2012) a U.S. Veterans Administration (clinic or hospital), (Piette et al, 2008;Piette et al, 2015) and in a clinical research center. (Dunbar et al, 2005) Two studies (Agren et al, 2012;Piette et al, 2008) included multiple sites to support the transition from hospital to home or increase recruitment.…”

“…The 12 interventions aligned into three delivery contexts -those which could be categorized as face-to-face; (Ågren et al, 2015;Agren et al, 2012;Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) telephone; (Piamjariyakul et al, 2015) or telehealth interventions (see Table 2). (Kenealy et al, 2015;Piette et al, 2008;Piette et al, 2015;Schwarz et al, 2008) Most face-to-face interventions also used some form of technology including DVD/video, (Bull et al, 2000;Dunbar et al, 2005;Srisuk et al, 2015) website, (Agren et al, 2012) or phone calls (Ågren et al, 2015;Dunbar et al, 2005;Dunbar et al, 2013;Srisuk et al, 2015) blurring the line between "high touch" and "high tech" modalities. It appears that all the studies were investigator-initiated and led.…”

“…Patient perceived control at 3 months (Ågren et al, 2015;Agren et al, 2012) and 12 months (Ågren et al, 2015) Carer perceived control at 3 months (Srisuk et al, 2015) Patient quality of life at 3 (Srisuk et al, 2015) and 6 months (Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) Patient preparedness to care at 2 weeks (Bull et al, 2000) Carer reaction to caregiving (Bull et al, 2000) Patient knowledge (Dunbar et al, 2013) Patient/Carer knowledge (Dunbar et al, 2005;Srisuk et al, 2015) Patient perceived control at 12 months (Agren et al, 2012) Carer perceived control at 6 months (Srisuk et al, 2015) Patient/Carer perceived control at 24 months (Liljeroos et al, 2015) Patient quality of life at 3 months (Schwarz et al, 2008) Patient/Carer quality of life at 3 months (Agren et al, 2012) Patient quality of life at 6 months (Kenealy et al, 2015) Carer preparedness to care at 6 months (Piamjariyakul et al, 2015) Patient/Carer satisfaction with care (Bull et al, 2000) Patient ( …”

“…Patient/Carer depression at 6 months (Kenealy et al, 2015;Piamjariyakul et al, 2015;Piette et al, 2015) Patient social support at 6 months (Piamjariyakul et al, 2015) Carer confidence (Piamjariyakul et al, 2015) Patient anxiety (Kenealy et al, 2015) Carer strain (Piette et al, 2015) Patient depression at 3 months, (Dunbar et al, 2005;Schwarz et al, 2008) Patient/Carer depression at 12 months (Ågren et al, 2015;Agren et al, 2012) and 24 months (Liljeroos et al, 2015) Carer social support at 3 months (Schwarz et al, 2008) Carer burden (Agren et al, 2012;Agren et al, 2015) Depression affective, and health services utilization). In the main outcome papers of the complete studies only one paper reported null findings on all outcomes.…”