BY AMERICAN HEART ASSOCIATION NEWS
ORLANDO, Florida – Using telemonitoring to keep heart failure patients on track after being discharged from the hospital failed to lower hospital readmission or deaths compared to regular care, according to a late breaking clinical trial presented Sunday at the 2015 American Heart Association Scientific Sessions.
Lead study author Michael K. Ong, M.D., Ph.D., said his study had hoped that telemonitoring could catch problems in heart failure patients sooner and avoid hospitalizations.
“If we have to wait for patients to come into the clinic, a lot can happen,” said Ong, associate professor at the University of California, Los Angeles. “We’d like to try to be able to intervene sooner so they don’t have to go the ER or hospital.”
Heart failure is a leading cause of hospitalization for Americans, according to the AHA. It’s a chronic, progressive condition in which the heart can’t pump enough blood to meet the body’s needs. More than 870,000 new cases reported annually, a number that’s expected to increase by nearly 40 percent in 15 years.
In the study, known as BEAT-HF, researchers found that the telemonitoring group had no better rates of hospital readmissions within 30 or 180 days than the regular care group. Deaths within 30 days dropped for the telemonitoring group, but Ong said this probably does not reflect the effects of telemonitoring. The intervention did not lower deaths within 180 days.
“You have to use the devices to benefit from it,” Ong said. “Even when we use what we think is a simple system, for heart failure patients it’s not so simple.”
He said dramatic technology advances from when they designed the system in 2010 and 2011, when BlackBerry mobile phones were the preferred technology, could have affected results. He said newer wearable devices like the Fitbit or Apple Watch are less obtrusive and show promise for monitoring heart failure patients in the future.
Six California hospitals enrolled 1,437 patients with a median age of 73. There were 715 patients in the tele-monitoring group, while 722 patients received regular care.
At discharge, a nurse at each participating hospital enrolled the patients in the study for six months.
Patients in the telemonitoring group were given simple discharge instructions. They were told to measure and transmit their weight, blood pressure, heart rate and whether they were taking their medications.
They received a Bluetooth-enabled digital scale and automated blood pressure machine with texting capabilities that transmitted the data via a cellular transmitter to a central call center at UCLA.
Three to four nurses monitored patient information, made reminder calls or called patients if they had a problem.
Call center nurses also checked in with patients weekly during the first month after their discharge. Patients were checked monthly during the rest of the study. If the nurses detected major changes in blood pressure, heart rate or medications taken, they could make additional calls or alert a physician.
Ong said that patients overall reported that they liked someone watching over them, but added that “not every technology is for everyone.”
He said future research may identify the patients most likely to benefit from telemonitoring.
“We have to find out what’s going to work in managing all these patients without seeing them in the clinic all the time,” said Mariell Jessup, M.D., AHA past president, and professor of medicine and medical director of the Heart and Vascular Center at the Hospital of the University of Pennsylvania in Philadelphia, in a media briefing. “There may be that there’s one more piece to the study that may be the magic formula. Or this hope in monitoring them remotely is just false hope.”
“There’s a lot of work that needs to be done about how to affect behavior change,” Ong added.