PREVENTION OF HOSPITALIZATIONS FOR HEART-FAILURE WITH AN INTERACTIVE HOME MONITORING PROGRAM

Congestive heart failure is the most common cause of hospitalization f or the older population. A previous study demonstrated that rehospital izations, undertaken by 30% to 50% of elderly patients, can be prevent ed with intensive multidisciplinary intervention. A pilot study was de signed to determine whether a less intensive program with patient educ ation materials, automated reminders for medication compliance, self-m onitoring of daily weights and vital signs, and facilitated telephone communication with a nurse-monitor could reduce hospitalizations and w hether this benefit could be extended to younger outpatients. Twenty-s even male patients (mean age 62 years) with New York Heart Association class II to IV congestive heart failure caused by dilated cardiomyopa thy underwent follow-up with an independent service, which provided th e primary cardiologist with information concerning changes in vital si gns or symptoms. The number of hospitalizations and hospital days duri ng the mean value of 8.5 months in the program was compared patient by patient with the number during the equivalent period before entrance in the program. The number of hospitalizations' for cardiovascular dia gnoses and hospital days was reduced from 0.6 to 0.2 (p = 0.09) per pa tient year of follow-up and 7.8 td 0.7 days per patient per year (p < 0.05). Hospitalizations for all causes fell from 0.8 to 0.4 per patien t per year (p = not significant) and 9.5 to 0.8 days per patient per y ear (p < 0.05). The greatest absolute and relative benefit was observe d among patients with more severe congestive heart failure. The most f requent indication for intervention was an increase in weight, which w as managed with adjustment of diuretic dosages. This preliminary exper ience suggests that close telephone monitoring by personnel from an in dependent service can prevent hospitalizations for heart failure among both recently discharged patients and ambulatory outpatients and amon g both elderly and middle-aged persons.