- A telemonitoring program for heart failure saw short-term benefits for participating patients although it had negligible effects in the long-term, according to a recent study in the Journal of Medical Internet Research.
A team of researchers evaluated the effect of the Connected Cardiac Care Program (CCCP) at Massachusetts General Hospital, a remote monitoring initiative aimed at reducing hospitalization and mortality. As part of their home monitoring system, patients at risk for health failure were equipment to record vital signs and view readings as well as tools for answering symptom questions and accessing educational materials on numerous topics (e.g., diet, physical activity, medication adherence).
In choosing a patient population for study, Agboola et al. remote monitoring database (RMDR), a secure health data repository housed and maintained by Partners HealthCare. A total of 348 patients, half of which enrolled in CCCP, were part of the analysis of mortality and hospital at 30-, 60-, 90-, and 120-day intervals.
After 30 days of enrollment in the health failure telemonitoring program, CCCP patients had a decrease in their hospitalization rate with half as many all-cause hospitalizations occurring during that duration as compared to members of the control group — 24 to 49, respectively.
After 60, 90, and 120 days, CCCP patients continued to experience fewer hospitalizations than their control counterparts:
- 60 days: 43 to 68
- 90 days: 56 to 87
- 120 days: 75 to 97
Agboola et al. observed a similar trend in mortality rates with twice as many deaths affecting the control group than CCCP enrollees — 12 to 5, respectively.
Despite these gains in the short-term, outcomes beyond the four-month period of the health failure telemonitoring program showed no significant change compared to the control group. "Of the 174 CCCP patients, 47% had at least one all-cause hospitalization over the 1-year follow-up period compared with 46% in controls," the researchers observe. In fact, the CCCP group had a higher risk of multiple hospitalizations and no difference in length of hospital stay at the 8- and 12-month marks.
"Altogether, these findings suggest that the program was associated with reduction in hospitalization and mortality rates during the 4-month program duration and kept patients alive who probably would have died had they not been enrolled in the remote monitoring program," write Agboola et al.
The authors contend the increased hospitalization and mortality for patients beyond the 4-month program period could be the result of "progressive nature of the disease, early disproportionate deaths of sicker controls, and also by the fact that participants had become dependent on being monitored remotely with regular access to monitoring devices and the telemonitoring nurses."
According to the researchers, additional investigation into the cause of higher hospitalization rates for CCCP patients is necessary and could reveal that the educational efforts of the health failure telemonitoring program fell short of building "sufficient self-competency" or that these patients were more acutely aware of early signs of heart failure as a result of training.
"Traditionally, remote monitoring is seen as a short-to-medium term adjunct to regular care to empower patients for self-management following hospitalization," the authors claim. "Long-term use is not usually feasible due to cost. However, based on our findings, we speculate that increasing the duration of the program to enable patients to develop self-competency may improve outcomes."
Read the full study here.