title: Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program.
abstract: BACKGROUND
  Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce.
  
  
  OBJECTIVE
  This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital.
  
  
  METHODS
  Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes.
  
  
  RESULTS
  A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31).
  
  
  CONCLUSIONS
  CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration.
authors.affiliation: Partners Healthcare Center for Connected Health, Connected Health Innovation, Boston, MA, United States. sagboola@mgh.harvard.edu.
authors.forename: Stephen
authors.identifier: http://orcid.org/0000-0002-2161-8091
authors.initials: S
authors.lastname: Agboola
authors.forename: Kamal
authors.identifier: http://orcid.org/0000-0002-0122-8002
authors.initials: K
authors.lastname: Jethwani
authors.forename: Kholoud
authors.identifier: http://orcid.org/0000-0002-3236-6248
authors.initials: K
authors.lastname: Khateeb
authors.forename: Stephanie
authors.identifier: http://orcid.org/0000-0003-3039-7072
authors.initials: S
authors.lastname: Moore
authors.forename: Joseph
authors.identifier: http://orcid.org/0000-0002-7517-2291
authors.initials: J
authors.lastname: Kvedar
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D009943:Organophosphorus Compounds; D052999:Quinazolinones; D019114:Remote Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009943:Organophosphorus Compounds; D052999:Quinazolinones; C079177:2-(5'-chloro-2'-phosphoryloxyphenyl)-6-chloro-4-(3H)-quinazolinone
keywords: heart failure; hospitalizations; mortality; remote monitoring; self-management; telemonitoring