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Daniel Benatar, MD; Mary Bondmass, RN; Jaime Ghitelman, MD; Boaz Avitall, MD, PhD

Arch Intern Med. 2003;163:347-352.

Background  Outcomes related to chronic heart failure (HF) remain relatively poor, despite advances in pharmacological therapy and medical and nursing care. Experts agree that outpatient care may be among the factors that affect HF outcomes. We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population.

Methods  A prospective, randomized design was used to compare HF outcomes from 216 patients randomized to 1 of 2 home health care delivery methods for 3 months after discharge. Care was delivered by the home nurse visit (HNV) or the nurse telemanagement (NTM) method. In the latter, patients used transtelephonic home monitoring devices to measure their weight, blood pressure, heart rate, and oxygen saturation. These data were transmitted daily to a secure Internet site. An advanced-practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone. Both delivery methods used the same HF-specific clinical guidelines to direct care. Outcomes include HF readmissions and length of stay, anxiety, depression, self-efficacy, and quality of life. Data were primarily tested using a 2-group analysis of variance (ANOVA). We used a repeated-measures ANOVA to conduct preintervention-postintervention analyses.

Results  After 3 months, patients in the NTM group (n = 108; mean ± SD age, 62.9 ± 13.2 years; 83% African American; 64% female) had fewer HF readmissions (13 vs 24; P.001) with shorter lengths of stay (49.5 vs 105.0 days; P.001) compared with the HNV group (n = 108; mean ± SD age, 63.2 ± 12.6 years; 89% African American; 62% female). Hospitalization charges at 3 months were less in the NTM group compared with the HNV group ($65 023 vs $177 365; P.02). At 6 and 12 months, cumulative readmission charges in the NTM group were also less ($223 638 vs $500 343 [P<.03] and $541 378 vs $677 710 [P.16], respectively) compared with the HNV group. Quality of life was significantly improved for both groups when we compared postintervention and preintervention scores.

Conclusion  The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced-practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care.

From the Section of Cardiology, Department of Medicine, University of Illinois at Chicago. Dr Avitall is the developer of the hardware and software.

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