Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial

Better Effectiveness After Transition-Heart Failure (BEAT-HF) Research Group

Research output: Contribution to journalArticle

148 Citations (Scopus)

Abstract

IMPORTANCE: It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. OBJECTIVE: To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. DESIGN, SETTING, AND PARTICIPANTS: We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30,2014, to October 1,2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. INTERVENTIONS: The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. MAIN OUTCOMES AND MEASURES: The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. RESULTS: Among 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P =.74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported. CONCLUSIONS AND RELEVANCE: Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions.

Original languageEnglish (US)
Pages (from-to)310-318
Number of pages9
JournalJAMA Internal Medicine
Volume176
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

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Patient Discharge
Physiologic Monitoring
Randomized Controlled Trials
Heart Failure
Telephone
Quality of Life
Patient Transfer
Mortality
Health
African Americans
Hospitalization
Heart Rate
Nurses
Blood Pressure
Weights and Measures
Equipment and Supplies
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial. / Better Effectiveness After Transition-Heart Failure (BEAT-HF) Research Group.

In: JAMA Internal Medicine, Vol. 176, No. 3, 01.03.2016, p. 310-318.

Research output: Contribution to journalArticle

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abstract = "IMPORTANCE: It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. OBJECTIVE: To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. DESIGN, SETTING, AND PARTICIPANTS: We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30,2014, to October 1,2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. INTERVENTIONS: The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. MAIN OUTCOMES AND MEASURES: The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. RESULTS: Among 1437 participants, the median age was 73 years. Overall, 46.2{\%} (664 of 1437) were female, and 22.0{\%} (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8{\%} (363 of 715) and 49.2{\%} (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95{\%} CI, 0.88-1.20; P =.74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported. CONCLUSIONS AND RELEVANCE: Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions.",
author = "{Better Effectiveness After Transition-Heart Failure (BEAT-HF) Research Group} and Ong, {Michael K.} and Romano, {Patrick S.} and Sarah Edgington and Aronow, {Harriet U.} and Auerbach, {Andrew D.} and Black, {Jeanne T.} and {De Marco}, Teresa and Escarce, {Jose J.} and Lorraine Evangelista and Barbara Hanna and Ganiats, {Theodore G.} and Greenberg, {Barry H.} and Sheldon Greenfield and Kaplan, {Sherrie H.} and Asher Kimchi and Honghu Liu and Dawn Lombardo and Mangione, {Carol M.} and Bahman Sadeghi and Banafsheh Sadeghi and Majid Sarrafzadeh and Kathleen Tong and Fonarow, {Gregg C.} and Bruce Davidson and Hassan Ghasemzadeh and Michael Gropper and Michelle Mourad and Arjang Ahmadpour and Wendy Davila and Susanne Engel and Ronald Jacolbia and Herman Lee and Laura Linares and Elizabeth Michel and Weyrich, {Meghan Soulsby} and Elizabeth Zellmer and Lida Esbati-Mashayekhi and Elisabeth Haddad and Marian Haskins and Tianne Larson and Kathryn Pratt and Hendry Ansorie and Kymberly Aoki and Ruth Baron and Eileen Brinker and Maureen Carroll and Annette Contasti and Anne Fekete and Vivian Guzman and Linda Larsen",
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T1 - Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial

AU - Better Effectiveness After Transition-Heart Failure (BEAT-HF) Research Group

AU - Ong, Michael K.

AU - Romano, Patrick S.

AU - Edgington, Sarah

AU - Aronow, Harriet U.

AU - Auerbach, Andrew D.

AU - Black, Jeanne T.

AU - De Marco, Teresa

AU - Escarce, Jose J.

AU - Evangelista, Lorraine

AU - Hanna, Barbara

AU - Ganiats, Theodore G.

AU - Greenberg, Barry H.

AU - Greenfield, Sheldon

AU - Kaplan, Sherrie H.

AU - Kimchi, Asher

AU - Liu, Honghu

AU - Lombardo, Dawn

AU - Mangione, Carol M.

AU - Sadeghi, Bahman

AU - Sadeghi, Banafsheh

AU - Sarrafzadeh, Majid

AU - Tong, Kathleen

AU - Fonarow, Gregg C.

AU - Davidson, Bruce

AU - Ghasemzadeh, Hassan

AU - Gropper, Michael

AU - Mourad, Michelle

AU - Ahmadpour, Arjang

AU - Davila, Wendy

AU - Engel, Susanne

AU - Jacolbia, Ronald

AU - Lee, Herman

AU - Linares, Laura

AU - Michel, Elizabeth

AU - Weyrich, Meghan Soulsby

AU - Zellmer, Elizabeth

AU - Esbati-Mashayekhi, Lida

AU - Haddad, Elisabeth

AU - Haskins, Marian

AU - Larson, Tianne

AU - Pratt, Kathryn

AU - Ansorie, Hendry

AU - Aoki, Kymberly

AU - Baron, Ruth

AU - Brinker, Eileen

AU - Carroll, Maureen

AU - Contasti, Annette

AU - Fekete, Anne

AU - Guzman, Vivian

AU - Larsen, Linda

PY - 2016/3/1

Y1 - 2016/3/1

N2 - IMPORTANCE: It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. OBJECTIVE: To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. DESIGN, SETTING, AND PARTICIPANTS: We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30,2014, to October 1,2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. INTERVENTIONS: The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. MAIN OUTCOMES AND MEASURES: The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. RESULTS: Among 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P =.74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported. CONCLUSIONS AND RELEVANCE: Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions.

AB - IMPORTANCE: It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. OBJECTIVE: To evaluate the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. DESIGN, SETTING, AND PARTICIPANTS: We randomized 1437 patients hospitalized for HF between October 12, 2011, and September 30, 2013, to the intervention arm (715 patients) or to the usual care arm (722 patients) of the Better Effectiveness After Transition-Heart Failure (BEAT-HF) study and observed them for 180 days. The dates of our study analysis were March 30,2014, to October 1,2015. The setting was 6 academic medical centers in California. Participants were hospitalized individuals 50 years or older who received active treatment for decompensated HF. INTERVENTIONS: The intervention combined health coaching telephone calls and telemonitoring. Telemonitoring used electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight. Centralized registered nurses conducted telemonitoring reviews, protocolized actions, and telephone calls. MAIN OUTCOMES AND MEASURES: The primary outcome was readmission for any cause within 180 days after discharge. Secondary outcomes were all-cause readmission within 30 days, all-cause mortality at 30 and 180 days, and quality of life at 30 and 180 days. RESULTS: Among 1437 participants, the median age was 73 years. Overall, 46.2% (664 of 1437) were female, and 22.0% (316 of 1437) were African American. The intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge, which occurred in 50.8% (363 of 715) and 49.2% (355 of 722) of patients, respectively (adjusted hazard ratio, 1.03; 95% CI, 0.88-1.20; P =.74). In secondary analyses, there were no significant differences in 30-day readmission or 180-day mortality, but there was a significant difference in 180-day quality of life between the intervention and usual care groups. No adverse events were reported. CONCLUSIONS AND RELEVANCE: Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions.

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