Postdischarge Telemonitoring, Telephone Coaching May Benefit Certain Patients With Heart Failure

Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) after discharge were associated with improved survival in certain patients hospitalized for acute decompensated heart failure (HF), according to a study published in Journal of Cardiac Failure.¹

“There's a lot of new technology and new ideas about how to manage people who have heart failure remotely, but we demonstrated that low-tech and old-fashioned talking on the phone, essentially monitoring the response to, ‘How are you feeling?’ can improve outcomes," Ilan Kedan, MD, professor of cardiology at Cedars-Sinai and corresponding author of the study, said in a statement.²

NTM uses objective data from noninvasive monitoring devices such as scales, blood pressure monitors, and heart rate monitors to complement telephone-based care transition; NTC entails scheduled telephone calls from a nurse coach and phone calls in response to abnormal results from noninvasive monitoring. There have been mixed results in previous studies of NTM and NTM-NTC for patients with HF, and the current study aimed to determine if different comorbidity burdens are associated with different readmission and mortality rates after NTM-NTC.

The post hoc analysis examined data from the randomized controlled Better Effectiveness After Transition - Heart Failure (BEAT-HF) trial. The study included patients admitted to 6 academic medical centers for acute decompensated HF between October 2011 and September 2013. All patients in the overall cohort received standard predischarge HF education. The NTM-NTC cohort received additional monitoring and phone calls to address abnormalities for 180 days. NTM consisted of weight, blood pressure, heart rate, and symptom burden.

A total of 1313 patients were included in the secondary analysis, with a mean age of 73.2 years. The NTM-NTC and usual care cohorts had similar demographic characteristics. Patients were stratified by comorbidity burden, which was determined by scoring complications and coexisting diagnoses from index hospital admissions. The high-comorbidity group was older and more likely to have Medicaid as a primary or secondary insurance provider.

Most patients (80.7%) fell into the moderate-comorbidity group (3-8 comorbidities), while 7.5% were classified as low (0-2 comorbidities) and 11.9% as high (9 or more comorbidities). Overall, the mean number of comorbidities was 5.7. Higher comorbidity burden correlated with readmission within 30 days, readmission within 180 days, mortality within 30 days, and mortality within 180 days. Over the 180-day study period, higher morbidity inversely correlated with days alive.

There were no statistically significant differences in the 30- or 180-day readmission rates in the NTM-NTC cohort compared with the control group—a finding in line with the main results of BEAT-HF. However, patients in the high comorbidity group who received NTM-NTC showed lower mortality at 30 days (HR, 0.25; 95% CI, 0.07-0.90) and 180 days (HR, 0.51; 95% CI, 0.27-0.98) after discharge. These patients also had significantly more days alive as well as days alive out of the hospital than their counterparts who received usual care.

The study was limited in its post hoc nature, as well as the inclusion of a subset of patients with complete coded index admission diagnostic and outcomes data. However, the findings suggest that patients with high comorbidity burdens may benefit substantially from intervention with NTM-NTC.

“What makes this study unique is our methodology, how we grouped people according to the number of comorbidities they had,” Kedan said. “Investigators may consider using a similar approach to identify which patients may benefit the most from HF interventions.”

References

1. Kimchi A, Aronow HU, Ni YM, et al. Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity. J Card Fail. 2022;S1071-9164(22)01221-0. doi:10.1016/j.cardfail.2022.11.012

2. Calling patients after heart failure may save lives. News release. Cedars-Sinai. January 16, 2023. Accessed February 17, 2023. https://www.cedars-sinai.org/newsroom/calling-patients-after-heart-failure-may-save-lives