No benefit from telemonitoring heart patients
■ A study finds no improvement for those who call in to update their health status compared with those who don't call.
By Carolyne Krupa — Posted Dec. 6, 2010
An automated call-in system to monitor heart failure patients and catch any downturn in their condition failed to show benefits, a new study says.
Heart failure patients are considered high risk after leaving the hospital. Fifty percent die or are rehospitalized within six months of discharge, said Sarwat I. Chaudhry, MD, co-author of the study, published online Nov. 16 in The New England Journal of Medicine.
"Patients who have chronic disease like heart failure are a vulnerable group," said Dr. Chaudhry, an assistant professor at Yale School of Medicine. "At the hospital, they receive 24-hour monitoring, so if there is any change, the doctors and nurses can respond immediately. Yet when they are discharged home, they are pretty much on their own."
With the telemonitoring system, physicians hoped to track patients more thoroughly.
"The thought is if you catch things early, maybe you can turn it around before it becomes so bad the patient has to be readmitted to the hospital," she said.
Researchers randomly assigned 826 of 1,653 recently hospitalized heart failure patients from 33 cardiology practices to undergo telemonitoring. The patients were instructed to call a toll-free telephone number daily and respond to a series of health-related questions.
After six months, there was no significant difference between the two patient groups. About half of patients in both groups were rehospitalized, and 11.1% of those in the telemonitoring group died compared with 11.4% in the usual care group, the study said.
Participation was an issue. In the telemonitoring group, 14% of patients never used the system, and only 55% were still calling in at least three times a week after six months.
Hospitals are under a lot of pressure to reduce readmissions, and several companies offer similar monitoring systems as a possible solution, Dr. Chaudhry said.
The study contradicts smaller studies and highlights the importance of testing new approaches, said senior study author Harlan Krumholz, MD, professor of medicine, epidemiology and public health at Yale.
"As we search for a new approach -- particularly approaches that change the way we practice -- we will need to evaluate them thoroughly to ensure that the resources we expend are providing benefit," he said.