title: Telemonitoring with case management for seniors with heart failure.
abstract: OBJECTIVE
  To assess the impact of supplementing nurse case management with Internet-connected telemonitoring on clinical outcomes in an elderly heart failure (HF) population.
  
  
  METHODS
  Randomized clinical trial allocating high-risk HF subjects to the telehealth system with case management (THCM) versus case management (CM) alone.
  
  
  METHODS
  Medicare Advantage members with HF and recent hospitalization were randomized to THCM or CM. Consenting participants received THCM for 6 months or the health plan's usual Medicare specialized CM as long as deemed necessary. The primary outcome measure was a composite of all-cause hospitalization, ED visit, or death. Because only a subset of those who were randomized consented and participated, the strategies were evaluated as-treated rather than by intention-to-treat, with multivariate adjustment in logistic regression models for confounding introduced by postrandomization exclusions.
  
  
  RESULTS
  The treated sample size was 164 subjects in THCM and 152 in CM. Treatment arms did not differ significantly for the primary composite outcome (45% for THCM vs 40% for CM, relative risk 1.18; P = .22). Telehealth alerts prompted frequent telephonic contact, increasing THCM case managers' workload. The participant population overall had 42% fewer inpatient days during the intervention period compared with the previous year.
  
  
  CONCLUSIONS
  Despite effective implementation of an Internet-based telehealth intervention in an elderly HF population, there was no discernible impact on overall morbidity or mortality. Notably, limited postrandomization participation decreased power to detect a difference. The reduction in days hospitalized for trial participants overall underscores the benefit of CM for such HF patients.
authors.affiliation: Aetna, Inc, Princeton, NJ 08540, USA. wadem1@aetna.com
authors.forename: Marcia J
authors.initials: MJ
authors.lastname: Wade
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.forename: Claire M
authors.initials: CM
authors.lastname: Spettell
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Snyder
authors.forename: Virginia
authors.initials: V
authors.lastname: McGowan-Stackewicz
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Kummer
authors.forename: Maureen C
authors.initials: MC
authors.lastname: Maccoy
authors.forename: Randall S
authors.initials: RS
authors.lastname: Krakauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000451:nursing / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009511:New England; D011446:Prospective Studies; D016019:Survival Analysis; D013686:Telemetry