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    Original Investigation
    Cardiology
    July 10, 2020

    Association of Adherence to Weight Telemonitoring With Health Care Use and Death: A Secondary Analysis of a Randomized Clinical Trial

    Author Affiliations
    • 1Center for Health and Technology, Department of Pediatrics, University of California, Davis, Sacramento
    • 2Center for Healthcare Policy and Research, Department of Pediatrics, University of California, Davis, Sacramento
    • 3Adventist Heart and Vascular Institute, St Helena, California
    • 4Center for Healthcare Policy and Research, Department of Public Health Sciences, University of California, Davis, Sacramento
    • 5Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
    • 6Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
    • 7Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla
    • 8Sue and Bill Gross School of Nursing, University of California, Irvine
    • 9Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
    • 10Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
    • 11Center for Healthcare Policy and Research, Division of General Medicine, University of California, Davis, Sacramento
    JAMA Netw Open. 2020;3(7):e2010174. doi:10.1001/jamanetworkopen.2020.10174
    Key Points español 中文 (chinese)

    Question  Is adherence to weight telemonitoring associated with health care use and death for patients with heart failure?

    Findings  This post hoc secondary analysis of a randomized clinical trial that included 538 participants found that an increase in weight telemonitoring adherence in a given week was associated with a significant decrease in the risk of subsequent hospitalization or death in the following week. Adherence was not associated with emergency department visits.

    Meaning  Adherence to telemonitoring may be associated with risk of hospitalization and death for patients with heart failure.

    Abstract

    Importance  Adherence to telemonitoring may be associated with heart failure exacerbation but is not included in telemonitoring algorithms.

    Objective  To assess whether telemonitoring adherence is associated with a patient’s risk of hospitalization, emergency department visit, or death.

    Design, Setting, and Participants  This post hoc secondary analysis of the Better Effectiveness After Transition–Heart Failure randomized clinical trial included patients from 6 academic medical centers in California who were eligible if they were hospitalized for decompensated heart failure and excluded if they were discharged to a skilled nursing facility, were expected to improve because of a medical procedure, or did not have the cognitive or physical ability to participate. The trial compared a telemonitoring intervention with usual care for patients with heart failure after hospital discharge from October 12, 2011, to September 30, 2013. Data analysis was performed from November 8, 2016, to May 10, 2019.

    Interventions  The intervention group (n = 722) received heart failure education, telephone check-ins, and a wireless telemonitoring system that allowed the patient to transmit weight, blood pressure, heart rate, and selected symptoms. The control group (n = 715) received usual care. Patients were followed up for 180 days after discharge.

    Main Outcomes and Measures  The main outcome was within-person risk of hospitalization, emergency department visit, or death by week during the study period. Poisson regression was used to determine the within-person association of adherence to daily weighing with the risk of experiencing these events in the following week.

    Results  Among the 538 participants (mean [SD] age, 70.9 [14.1] years; 287 [53.8%] male; 269 [50.7%] white) in the present analysis, adherence was lowest during the first week after enrollment but steadily increased, peaking between days 26 and 60 at 69%, or 371 transmissions. Adherence to weight telemonitoring was associated with events in the following week; an increase in adherence by 1 day was associated with a 19% decrease in the rate of death in the following week (incidence rate ratio, 0.81; 95% CI, 0.73-0.90) and an 11% decrease in the rate of hospitalization (incidence rate ratio, 0.89; 95% CI, 0.86-0.91). Adherence in the previous week was not associated with reduced rates of emergency department visits (incidence rate ratio, 0.95; 95% CI, 0.90-1.02).

    Conclusions and Relevance  In this study, lower adherence to weight telemonitoring in a given week was associated with an increased risk of subsequent hospitalization or death in the following week. It is unlikely that this is a result of the telemonitoring intervention; rather, adherence may be an important factor associated with a patient’s health status.

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