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Original Investigation
Health Care Reform
March 2016

Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart FailureThe Better Effectiveness After Transition–Heart Failure (BEAT-HF) Randomized Clinical Trial

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
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.

Trial Registration  clinicaltrials.gov Identifier: NCT01360203

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