Managing heart failure care using an internet-based telemedicine system.
BACKGROUND
Managing patients with heart failure (HF) is labor intensive, and follow-up is often inadequate to detect day-to-day changes that ultimately lead to decompensation. We tested the effect of an Internet-based telemedicine (T) system that provides frequent surveillance and increased communicate between HF patients and their provider on frequency of hospitalization in a cohort of patients with advanced HF.


RESULTS
HF patients in NYHA Class II-IV were randomized to usual care (UC, n = 24) or T (T plus UC, n = 24) and followed for 1 year. Office visits, emergency department visits, hospitalizations, telephone calls, and number of Internet communications were measured over the 1-year period. Left ventricular ejection fraction (EF) was assessed by echocardiography in both groups. For T, mean age was 53.2 +/- 2.0 years (72% male, 61% Caucasian, 39% African American). For UC, mean age was 54.1 +/- 2.6 years (76% male, 72% Caucasian, 14% African American, and 14% Hispanic). HF etiologies and EF were similar in both groups. During the 12-month period, UC had 74 total phone calls to the practice, whereas T had 88 telephone calls plus 1887 telemedicine data messages (6.5 messages/patient/month). ER visits were lower in the T group (T 5, UC 12; P < .05). Hospital admissions (T 24, C 40; P = .025) and total hospital days (T 84, UC 226 days; P < .005) were lower in T. Unscheduled clinic visits (T 13, UC 13; P = NS) and scheduled clinic visits (T 78, UC 94; P = NS) were similar in both groups.


CONCLUSIONS
Frequent monitoring and patient management using a telemedicine system may help to reduce hospitalizations, hospital days, and emergency department visits.
Kashem
Abul
A
Section of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Droogan
Marie T
MT
Santamore
William P
WP
Wald
Joyce W
JW
Bove
Alfred A
AA
D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D020407:Internet; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011159:Population Surveillance; D011446:Prospective Studies; D013318:Stroke Volume; D017216:Telemedicine / Q000458:organization & administration*; D014463:Ultrasonography