Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure.
BACKGROUND
Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for improving clinical outcomes. However, the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown. The aim of the study was to determine whether a home-based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow-up programme over a one-year period.


RESULTS
Four hundred-sixty CHF patients (pts), aged 57+/-10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one-year hospital readmission for cardiovascular reasons. During one-year follow-up 55 pts (24%) in HBT group and 83 pts (36%) in UC group had at least one readmission (RR=0.56; 95% CI: 0.38-0.82; p=0.01). After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR=0.50, 95% CI: 0.34-0.73; p=0.01). The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group). The rate of hearth failure-related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR=0.49, 95% [CI]: 0.31-0.76; p=0.0001). No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was significantly lower in HBT group (euro 843+/-1733) than in UC group (euro 1298+/-2322), (-35%, p<0.01).


CONCLUSIONS
This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.
Giordano
A
A
Cardiology Department, Fondazione Salvatore Maugeri, IRCCS, Gussago, BS, Italy.
Scalvini
S
S
Zanelli
E
E
Corrà
U
U
Longobardi
G L
GL
Ricci
V A
VA
Baiardi
P
P
Glisenti
F
F
D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D018575:Home Care Services, Hospital-Based / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics* / Q000639:trends; D017216:Telemedicine / Q000191:economics* / Q000379:methods*