The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring

Abstract

Background: Weight telemonitoring may be an effective way to improve patients' ability to manage heart failure and prevent unnecessary utilization of health services. However, the effectiveness of such interventions is dependent upon patient adherence. Objective: The purpose of this study was to determine how adherence to weight telemonitoring changes in response to 2 types of events: hospital readmissions and emergency department visits. Methods: The Better Effectiveness After Transition-Heart Failure trial examined the effectiveness of a remote telemonitoring intervention compared with usual care for patients discharged to home after hospitalization for decompensated heart failure. Participants were followed for 180 days and were instructed to transmit weight readings daily. We used Poisson regression to determine the within-person effects of events on subsequent adherence. Results: A total of 625 events took place during the study period. Most of these events were rehospitalizations (78.7%). After controlling for the number of previous events and discharge to a skilled nursing facility, the rate for adherence decreased by nearly 20% in the 2 weeks after a hospitalization compared with the 2 weeks before (adjusted rate ratio, 0.81; 95% confidence interval: 0.77-0.86; P < .001). Conclusions: Experiencing a rehospitalization had the effect of diminishing adherence to daily weighing. Providers using telemonitoring to monitor decompensation and manage medications should take advantage of the potential "teachable moment" during hospitalization to reinforce the importance of adherence.

Remote Monitoring in Heart Failure: Recent Trends and Future Perspectives

“…A research was conducted on 292 individuals with heart failure to see how hospitalisation and Emergency Department visits affected adherence to daily weight telemonitoring. The results show that rehospitalization reduced adherence to daily weight telemonitoring 10 . A further follow-up study with 538 participants found that lower compliance to weight telemonitoring in a week was associated with increased rehospitalisation and mortality 11 .…”

Remote Monitoring in Chronic Heart Failure Patients: Is Non-Invasive Remote Monitoring the Way to Go?

“…In total, 30 studies investigating non-invasive telemonitoring have been identified, including a total of 8892 patients [ 24 , 32 , 42 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. The study characteristics, as well as the reported outcomes on all-cause mortality, all-cause hospitalization, and HF-related hospitalization rates of the five largest studies, representing 52% (4606) of all patients, will be discussed in detail below [ 24 , 51 , 52 , 61 , 64 ].…”

“…The study characteristics, as well as the reported outcomes on all-cause mortality, all-cause hospitalization, and HF-related hospitalization rates of the five largest studies, representing 52% (4606) of all patients, will be discussed in detail below [ 24 , 51 , 52 , 61 , 64 ]. The study characteristics and outcomes of the other 25 studies will be summarized below [ 32 , 42 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 62 , 63 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ].…”

“…Twelve of these other studies reported data on monitoring adherence, ranging from 46% up to 95% [ 47 , 48 , 50 , 54 , 55 , 56 , 59 , 60 , 63 , 65 , 69 , 73 ]. Importantly to note, the monitoring strategy’s adherence decreased when the patients had to perform multiple measurements [ 48 , 50 , 73 ].…”

“…Additionally, the adherence decreased over time [ 48 , 50 , 55 , 56 ]. Surprisingly, the adherence also decreased in the weeks after hospitalization [ 47 ]. These results highlight that some studies’ adherence was far from optimal and could be even lower in a ‘real world’ setting.…”