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Original Investigation | Health Care Reform

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

Michael K. Ong, MD, PhD1,2; Patrick S. Romano, MD, MPH3,4; Sarah Edgington, MA1; Harriet U. Aronow, PhD5; Andrew D. Auerbach, MD, MPH6; Jeanne T. Black, PhD, MBA7; Teresa De Marco, MD6; Jose J. Escarce, MD, PhD1,8,9; Lorraine S. Evangelista, RN, PhD10; Barbara Hanna, RN, PhD11; Theodore G. Ganiats, MD12,13; Barry H. Greenberg, MD14; Sheldon Greenfield, MD, MPH15; Sherrie H. Kaplan, PhD, MPH15; Asher Kimchi, MD16; Honghu Liu, PhD17; Dawn Lombardo, MD15; Carol M. Mangione, MD, MSPH1,8; Bahman Sadeghi, MD, MBS1; Banafsheh Sadeghi, MD, PhD3; Majid Sarrafzadeh, PhD18,19; Kathleen Tong, MD3; Gregg C. Fonarow, MD1 ; for the Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group
[+] Author Affiliations
1Department of Medicine, University of California, Los Angeles
2Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
3Department of Internal Medicine, University of California, Davis
4Department of Pediatrics, University of California, Davis
5Office of Nursing Research and Development, Cedars-Sinai Medical Center, Los Angeles, California
6Department of Medicine, University of California, San Francisco
7Department of Resource and Outcomes Management, Cedars-Sinai Medical Center, Los Angeles, California
8Department of Health Policy & Management, University of California, Los Angeles
9RAND Health, RAND Corporation, Santa Monica, California
10Program in Nursing Science, University of California, Irvine
11School of Nursing, University of California, Davis
12Department of Family and Preventive Medicine, University of California, San Diego
13Department of Family Medicine and Community Health, University of Miami, Miami, Florida
14Department of Medicine, University of California, San Diego
15Department of Medicine, University of California, Irvine
16Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
17Division of Public Health & Community Dentistry, University of California, Los Angeles
18Department of Computer Science, University of California, Los Angeles
19Department of Electrical Engineering, University of California, Los Angeles
JAMA Intern Med. 2016;176(3):310-318. doi:10.1001/jamainternmed.2015.7712.
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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.

Trial Registration  clinicaltrials.gov Identifier: NCT01360203

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Figure 1.
BEAT-HF CONSORT Flow Diagram

BEAT-HF indicates Better Effectiveness After Transition–Heart Failure; CONSORT, Consolidated Standards of Reporting Trials.

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Figure 2.
Hazard Ratios for Readmission and Mortality at 30 Days and 180 Days

Dashed lines are for the intervention, and solid lines are for usual care. Adjusted hazard ratios, 95% CIs, and P values are from multivariable Cox proportional hazards regression models for readmission and mortality analyses. Models controlled for age, sex, race/ethnicity, insurance, income, social isolation, comorbidities, year, and quarter of enrollment, with enrollment site controlled for as random effects. A and B, The hazard ratio for 30-day readmission with the intervention is 1.03 (95% CI, 0.83-1.29; P = .77). The adjusted hazard ratio for 30-day readmission with the intervention is 1.01 (95% CI, 0.80-1.28; P = .91). The hazard ratio for 180-day readmission with the intervention is 1.03 (95% CI, 0.89-1.19; P = .73). The adjusted hazard ratio for 180-day readmission with the intervention is 1.03 (95% CI, 0.88-1.20; P = .74). C and D, The hazard ratio for 30-day mortality with the intervention is 0.61 (95% CI, 0.37-1.02; P = .06). The adjusted hazard ratio for 30-day mortality with the intervention is 0.53 (95% CI, 0.31-0.93; P = .03). The hazard ratio for 180-day mortality with the intervention is 0.88 (95% CI, 0.67-1.15; P = .32). The adjusted hazard ratio for 180-day mortality with the intervention is 0.85 (95% CI, 0.64-1.13; P = .26).

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Medications
Posted on February 13, 2016
G T A Morris
Retired
Conflict of Interest: None Declared
I was struck by the absence of Statins from the medication list in the article. I would suppose it likely that all meds were studied but nothing of importance was found. Trying to assign a cause for the decompensation is a part of management that telemetry would be expected to help. It is disappointing that so many dropped out. Was atrial fibrillation found more often in the treated group?
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