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.

Ong MK1, Romano PS2, Edgington S3, Aronow HU4, Auerbach AD5, Black JT6, De Marco T5, Escarce JJ7, Evangelista LS8, Hanna B9, Ganiats TG10,Greenberg BH11, Greenfield S12, Kaplan SH12, Kimchi A13, Liu H14, Lombardo D12, Mangione CM15, Sadeghi B3, Sadeghi B16, Sarrafzadeh M17, Tong K16,Fonarow GC3; Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group.

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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 academicmedical 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.