Elsevier

Journal of Cardiac Failure

Volume 29, Issue 12, December 2023, Pages 1642-1654
Journal of Cardiac Failure

Association Between Participation in a Heart Failure Telemonitoring Program and Health Care Utilization and Death Within an Integrated Health Care Delivery System

https://doi.org/10.1016/j.cardfail.2023.04.013Get rights and content

Abstract

Background

The clinical usefulness of remote telemonitoring to reduce postdischarge health care use and death in adults with heart failure (HF) remains controversial.

Methods and Results

Within a large integrated health care delivery system, we matched patients enrolled in a postdischarge telemonitoring intervention from 2015 to 2019 to patients not receiving telemonitoring at up to a 1:4 ratio on age, sex, and calipers of a propensity score. Primary outcomes were readmissions for worsening HF and all-cause death within 30, 90, and 365 days of the index discharge; secondary outcomes were all-cause readmissions and any outpatient diuretic dose adjustments. We matched 726 patients receiving telemonitoring to 1985 controls not receiving telemonitoring, with a mean age of 75 ± 11 years and 45% female. Patients receiving telemonitoring did not have a significant reduction in worsening HF hospitalizations (adjusted rate ratio [aRR] 0.95, 95% confidence interval [CI] 0.68–1.33), all-cause death (adjusted hazard ratio 0.60, 95% CI 0.33–1.08), or all-cause hospitalization (aRR 0.82, 95% CI 0.65–1.05) at 30 days, but did have an increase in outpatient diuretic dose adjustments (aRR 1.84, 95% CI 1.44–2.36). All associations were similar at 90 and 365 days postdischarge.

Conclusions

A postdischarge HF telemonitoring intervention was associated with more diuretic dose adjustments but was not significantly associated with HF-related morbidity and mortality.

Section snippets

Setting and Source Population

Kaiser Permanente Northern California (KPNC) is a large integrated health care delivery system with 21 hospitals and >260 freestanding clinics where >4.5 million members receive comprehensive care (ie, inpatient, emergency department, and ambulatory encounters). Membership is highly representative of the local and statewide population with respect to age, gender, race/ethnicity, and socioeconomic status.18, 19, 20 This study was approved by the KPNC Institutional Review Board, and a waiver of

Matched Cohort Assembly and Characteristics

We identified 1532 patients receiving telemonitoring after hospitalization between January 1, 2015, and December 31, 2019. During the same timeframe, we identified 201,008 eligible hospitalizations without telemonitoring as potential controls, with 63,705 (31.7%) occurring within participating KPNC facilities and 137,202 (68.3%) within other KPNC facilities. After matching on age, sex, index hospitalization type, and propensity score, the final analytic cohort consisted of 726 telemonitored

Discussion

In a large, retrospective, matched cohort study within an integrated health care delivery system, we found that a postdischarge HF intervention centered around remote telemonitoring was not associated with significant differences in readmissions for WHF, all-cause death, or all-cause readmissions within 30, 90, or 365 days after discharge. However, participation in the intervention was associated with an increase in adjustments in the dose or frequency of diuretics.

The strength of the

Lay summary

It is unclear whether monitoring of vital signs and symptoms at home can help to prevent readmissions and death among patients recently hospitalized for heart failure. In this study, we evaluated a program that offered monitoring to patients hospitalized for heart failure between 2015 and 2019. We used electronic health records to identify similar patients in that time who were not monitored and compared the rates of readmission, death, and the number of oral diuretic dose adjustments by

How this work applies to patients

  • •

    Remote ambulatory telemonitoring is often offered to patients with heart failure after a hospitalization or clinical event to help manage symptoms and prevent readmissions.

  • •

    In a retrospective analysis of a real-world telemonitoring-based intervention, telemonitoring was not associated with decreases in hospitalizations or death, but was associated with increases in the frequency of diuretic adjustments and clinical contacts.

  • •

    Additional prospective randomized controlled trials are needed to

Disclosures

ASG has received relevant research support through grants to his institution from the National Heart, Lung and Blood Institute; National Institute of Diabetes, Digestive and Kidney Diseases; National Institute on Aging; Amarin Pharma, Inc.; Novartis; Janssen Research & Development; and CSL Behring. APA is supported by a Mentored Patient-Oriented Research Career Development Award (K23HL150159) through the National Heart, Lung, and Blood Institute and has received relevant research support

Acknowledgments

The authors thank all the heart failure care managers, registered nurses, licensed vocational nurses, cardiologists, internal medicine and family medicine physicians, and support staff who provide high-quality care for our patients with heart failure.

Sources of Funding

The study was funded by The Permanente Medical Group (TPMG) Delivery Science Research Program. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication.

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