title: Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Impact of telemonitoring at home on the management of elderly patients with congestive heart failure Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. Long-Term Healthcare and Cost Outcomes of Disease Management in a Large, Randomized, Community-Based Population With Heart Failure Prevalence of heart failure and systolic ventricular dysfunction in older Australians: the Canberra Heart Study. A multicenter disease management program for hospitalized patients with heart failure. Home telemonitoring in heart failure patients: the HHH study (Home or Hospital in Heart Failure) Randomized controlled trial of telephone case management in Hispanics of Mexican origin with heart failure. A randomized clinical trial of the clinical effects of enhanced heart failure monitoring using a computer-based telephonic monitoring system in older minorities and women. Case management in a heterogeneous congestive heart failure population: a randomized controlled trial. [Impact of telemetric management on overall treatment costs and mortality rate among patients with chronic heart failure]. Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure
abstract: BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches We studied the effects of home telemonitoring in elderly patients with congestive heart failure ( CHF ) on mortality and rate of hospitalization , compliance with treatment , quality of life and costs of CHF management , by comparison with a group receiving usual care . Fifty-seven elderly CHF patients were r and omized to st and ard care or to home telemonitoring-based care  and followed for 12 months . In the subjects who were monitored , weekly reports on their clinical status were obtained and their management was modified accordingly . Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations ( P = 0.006 ) , a better compliance with therapy , more frequent use of beta-blockers and statins , lower total cholesterol level and a better reported health perception score . The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure Background —Because of the prevalence and expense of congestive heart failure ( CHF ) , significant efforts have been made to develop disease management ( DM ) programs that will improve clinical and financial outcomes . The effectiveness of such programs in a large , heterogeneous population of CHF patients remains unknown . Methods and Results —We r and omized 1069 patients ( aged 70.9±10.3 years ) with systolic ( ejection fraction 35±9 % ) or echocardiographically confirmed diastolic heart failure ( HF ) to assess telephonic DM over an 18-month period . Data were collected at baseline and at 6-month intervals . Survival analysis was performed by Kaplan-Meier and Cox regression methods . Healthcare utilization was defined after extensive record review , with an attempt to account for all inpatient and outpatient visits , medications , and diagnostic tests . We obtained data on 92 % of the patients , from nearly 53 000 health-related encounters . Total cost per patient was defined by adding estimated costs for the observed encounters , excluding the cost of the DM . Kaplan-Meier analysis showed that DM patients had a reduced mortality rate ( P=0.037 ) , with DM patients surviving an average of 76 days longer than controls . Subgroup analysis showed that DM had beneficial outcomes in patients with systolic HF ( hazard ratio 0.62 ; P=0.040 ) , which was more pronounced in NYHA classes III and IV . Although improvements in NYHA class were more likely with DM ( P<0.001 ) , 6-minute walk data from 217 patients in whom data were available at each visit showed no significant benefit from DM ( P=0.08 ) . Total and CHF-related healthcare utilization , including medications , office or emergency department visits , procedures , or hospitalizations , was not decreased by DM . Repeated- measures ANOVA for cost by group showed no significant differences , even in the higher NYHA class groups . Conclusions —Participation in DM result ed in a significant survival benefit , most notably in symptomatic systolic HF patients .  Although DM was associated with improved NYHA class , 6-minute walk test results did not improve . Healthcare utilization was not reduced by DM , and it conferred no cost savings . DM in HF results in improved life expectancy but does not improve objective measures of functional capacity and does not reduce cost OBJECTIVE To estimate the prevalence of heart failure ( HF ) and left ventricular ( LV ) systolic dysfunction in a population -based sample of older Australians . DESIGN , SETTING AND PARTICIPANTS A cross-sectional survey of 2000 r and omly selected residents of Canberra , aged 60 - 86 years , conducted between February 2002 and June 2003 . Participants were assessed by history , physical examination by a cardiologist , and echocardiography . MAIN OUTCOME MEASURES Age- and sex-specific prevalence rates of clinical HF and LV systolic dysfunction ( defined as LV ejection fraction < or = 50 % ) . RESULTS Of 1846 people eligible for our study , 1388 ( 75 % ) agreed to participate and 1275 completed all investigations ( mean age , 69.4 years ; 50 % men ) . In the study sample , 72 subjects ( 5.6 % ; 95 % CI , 4.4%-7.1 % ) had clinical HF that had been previously diagnosed and was confirmed by our assessment . A further 0.6 % ( 95 % CI , 0.3%-1.2 % ) had undiagnosed clinical HF ( ie , evidence of structural heart disease and symptoms/signs of cardiac insufficiency without a previous diagnosis of clinical HF ) . Thus , the overall prevalence of clinical HF in the sample was 6.3 % ( 95 % CI , 5.0%-7.7 % ) . Clinical HF increased in prevalence with advancing age ( a 4.4-fold increase from the 60 - 64-years age group to the 80 - 86-years age group ; P < 0.0001 ) . Of the 75 subjects ( 5.9 % ; 95 % CI , 4.7%-7.3 % ) with LV systolic dysfunction , 44 ( 59 % ) were in the pre clinical stage of disease . CONCLUSION Diagnosed HF cases represent the " tip of the iceberg " for the national burden of HF and LV systolic dysfunction . Clinical ly identifiable HF cases can remain undiagnosed , and the majority of people with LV systolic dysfunction are in a pre clinical stage of the disease BACKGROUND Despite the availability of proven therapies , outcomes in patients with heart failure ( HF ) remain poor . In this 2-stage , multicenter trial , we evaluated the effect of a disease management program on clinical and economic outcomes in patients with HF . METHODS AND RESULTS In Stage 1 , a pharmacist or nurse assessed each patient and made recommendations to the physician to add or adjust angiotensin-converting enzyme ( ACE ) inhibitors and other HF medications . Before discharge ( Stage 2 ) , patients were r and omized to a patient support program ( PSP ) ( education about HF , self-monitoring , adherence aids , newsletters , telephone hotline , and follow-up at 2 weeks , then monthly for 6 months after discharge ) or usual care . In Stage 1 ( 766 patients )  ACE inhibitor use increased from 58 % on admission to 83 % at discharge ( P < .0001 ) , and the daily dose ( in enalapril equivalents ) increased from 11.3 + /- 8.8 mg to 14.5 + /- 8.8 mg ( P < .0001 ) . In Stage 2 ( 276 patients ) there was no difference in ACE inhibitor adherence , but a reduction in cardiovascular-related emergency room visits ( 49 versus 20 , P = .030 ) , hospitalization days ( 812 versus 341 , P = .003 ) , and cost of care ( 2,531 Canadian dollars less per patient ) in favor of the PSP . CONCLUSION Simple interventions can improve ACE inhibitor use and patient outcomes The Home or Hospital in Heart failure ( HHH ) study was a European Community‐funded , multinational , r and omized controlled clinical trial , conducted in the UK , Pol and , and Italy , to assess the feasibility of a new system of home telemonitoring ( HT ) . The HT system was used to monitor clinical and physiological parameters , and its effectiveness ( compared with usual care ) in reducing cardiac events in heart failure ( HF ) patients was evaluated . Measurements were patient‐managed BACKGROUND Disease management is effective in the general population , but it has not been tested prospect ively in a sample of solely Hispanics with heart failure ( HF ) . We tested the effectiveness of telephone case management in decreasing hospitalizations and improving health-related quality of life ( HRQL ) and depression in Hispanics of Mexican origin with HF . METHODS AND RESULTS Hospitalized Hispanics with chronic HF ( n = 134 ) were enrolled and r and omized to intervention ( n = 69 ) or usual care ( n = 65 ) . The sample was elderly ( 72 + /- 11 years ) , New York Heart Association class III/IV ( 81.3 % ) , and poorly educated ( 78.4 % less than high school education ) . Most ( 55 % ) were unacculturated into US society . Bilingual/bicultural Mexican-American registered nurses provided 6 months of st and ardized telephone case management . Data on hospitalizations were collected from automated systems at 1 , 3 , and 6 months after the index hospital discharge . Health-related quality of life and depression were measured by self-report at enrollment , 3 , and 6 months . Intention to treat analysis was used . No significant group differences were found in HF hospitalizations , the primary outcome variable ( usual care : 0.49 + /- 0.81 [ CI 0.25 - 0.73 ] ; intervention : 0.55 + /- 1.1 [ CI 0.32 - 0.78 ] at 6 months ) . No significant group differences were found in HF readmission rate , HF days in the hospital , HF cost of care , all-cause hospitalizations or cost , mortality , HRQL , or depression . CONCLUSION These results have important implication s because of the current widespread enthusiasm for disease management . Although disease management is effective in the mainstream HF patient population , in Hispanics this ill , elderly , and poorly educated , a different approach may be needed BACKGROUND Prior studies suggest that disease management programs may be effective in improving clinical outcomes in patients with heart failure ( HF ) . However , the use of these programs in setting s with limited sources and among diverse population is not know . Thus the present study was design ed to assess the impact of a computer-based home disease management program ( Alere DayLink HF Monitoring System [ HFMS ] ) on the clinical outcomes of Medicare beneficiaries with HF who were elderly , women , and non-white males who received the care from a community-based primary care practitioner . METHODS AND RESULTS The Heart Failure Home Care ( HFHC ) trial was a multicenter , r and omized , controlled trial of HFMS versus st and ard heart failure care ( SC : enhanced patient education , education to clinicians , and follow-up ) . The primary study end point was treatment failure , defined as a composite of cardiovascular death or rehospitalization for heart failure within 6 months of enrollment . Among patients rehospitalized for HF , length of hospital stay was also considered a primary end point . A total of 315 patients were r and omized : 160 to HFMS and 155 to SC . Although the incidence of the primary outcome was somewhat higher in the SC arm ( 28.8 % versus 21.2 % , P = .15 ) , the difference was not statistically different . The length of hospital stay was also similar in both groups . CONCLUSIONS Our study results suggest that enhanced patient education and follow-up is as successful as a sophisticated home monitoring device with an interactive program in patients with HF who are elderly , women and non-Caucasian males and receive the care from a community-based primary care practitioner BACKGROUND Both r and omized and nonr and omized controlled studies have linked congestive heart failure ( CHF ) case management ( CM ) to decreased readmissions and improved outcomes in mostly homogeneous setting s. The objective of this r and omized controlled trial was to test the effect of CHF CM on the 90-day readmission rate in a more heterogeneous setting . METHODS A total of 287 patients admitted to the hospital with the primary or secondary diagnosis of CHF , left ventricular dysfunction of less than 40 % , or radiologic evidence of pulmonary edema for which they underwent diuresis were r and omized . The intervention consisted of 4 major components : early discharge planning , patient and family CHF education , 12 weeks of telephone follow-up , and promotion of optimal CHF medications . RESULTS The 90-day readmission rates were equal for the CM and usual care groups ( 37 % ) . Total inpatient and outpatient median costs and readmission median cost were reduced 14 % and 26 % , respectively , for the intervention group . Patients in the CM group were more likely to be taking CHF medication at target doses , but dosages did not increase significantly throughout 12 weeks . Although both groups took their medications as prescribed equally well , the rest of the adherence to treatment plan was significantly better in the CM group . Subgroup analysis of patients who lived locally and saw a cardiologist showed a significant decrease in CHF readmissions for the intervention group ( P = .03 ) . CONCLUSIONS These results suggest several limitations to the generalizability of the CHF CM-improved outcome link in a heterogeneous setting . One explanation is that the lack of coordinated system supports and varied accessibility to care in an extended , nonnetworked physician setting limits the effectiveness of the CM BACKGROUND AND OBJECTIVE The rising prevalence of chronic heart failure ( CHF ) has led to an increase in total treatment expenditures . A medical care programme of telemetry was developed to reduce the number of patients with decompensated CHF , hospital admissions and overall treatment cost . PATIENTS AND METHODS As part of a prospect i ve controlled study the body weight of 251 patients with CHF was monitored over one year . The supervising center contacted the patients whenever their body weight exceeded a threshold value . Patients were phoned by a design ated personal adviser and received regular informative material and advice by specialist medical personnel . Patients ' general practitioners had been involved in recruiting patients and by regularly sending them follow-up reports . Another group of 251 patients who had not received the described telemetric intervention served as control . RESULTS The mean age of the patients was 71.7 years , lower than the 76.4 years of the control group . More patients in the intervention groups were in NYHA class III and IV than in the control group ( 52 % vs 36 % ) . After an average observation period of 12 months the duration of hospital stay had been reduced by 48 % ( p = 0.01 ) , the hospital costs by EUR 7128 per patient p = 0.01 ) , while drug expenditure had increased by EUR 245 per patient ( not significant ) . The total costs had thus fallen by EUR 6993 per patient ( -39.5 % ; p = 0.05 ) . The mortality rate of 14.7 % in the intervention group was significantly lower than that of the control group of 27.1 % ( p = 0.001 ) . The reduction in costs and mortality rate was clearly greater for men than women . Total expenditure had been highest for patients who had died . CONCLUSION The results indicate that total treatment costs and mortality rate can be reduced by telemetric monitoring of  patients in CHF , especially in men Patients with a diagnosis of heart failure , registered at the study practice , were recruited into the study . First , they had a cardiologist 's assessment . They were then r and omised into telemonitored patients who measured pulse , BP , weight and video consulted , and controls
target: Conclusion : Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the r and omized controlled trials , older people with heart failure did benefit from structured telephone support and telemonitoring .
  While further research is required to confirm these observational findings , the evidence at h and indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure
background: Background : There are few data regarding the effectiveness of remote monitoring for older people with heart failure .
  We conducted a post-hoc sub- analysis of a previously published large Cochrane systematic review and meta- analysis of relevant r and omized controlled trials to determine whether structured telephone support and telemonitoring were effective in this population .