Navigate Up
UPMC/University of Pittsburgh Schools of the Health Sciences

Manager
Telephone: 412-647-9966

Patients and medical professionals may call 1-800-533-UPMC (8762) for more information.
 

University of Pittsburgh Schools of the Health Sciences

University of Pittsburgh Researchers Study Efficacy of a Home Heart Monitoring System

Tests showed little benefit in community setting

PITTSBURGH, October 19, 2007  Despite additional and sophisticated monitoring of heart failure patients in a community home setting, an interactive program failed to show any statistical effect in reducing cardiovascular deaths and readmission rates within six months after discharge in a group of elderly, non-Caucasian men and women with heart failure who were Medicare beneficiaries. University of Pittsburgh lead author, Z. Ozlem Soran, M.D., M.P.H., F.A.C.C., associate professor of medicine, associate professor of epidemiology/research, and director of the EECP Research Lab at the University of Pittsburgh Medical Center (UPMC) Cardiovascular Institute, presented these findings at the 11th Annual Scientific Meeting of the Heart Failure Society of America recently in Washington, D.C.

Disease management programs provide substantive benefit, especially for patients cared for by cardiologists at academic or community hospital-based tertiary care facilities. However, the typical heart failure patient is not treated by a cardiologist or by a chronic care team but instead, by a primary care physician in a community setting. Furthermore, information is even more limited regarding the success of home care disease management amongst women, non-Caucasian men, or patients in lower socio-economic groups compared to Caucasian men. Limitations of disease management programs need to be addressed and overcome so that care of heart failure patients can be successful, said Dr. Soran.

Home monitoring systems are not intended to replace medical office visits, but do hold the potential to reduce the number of hospitalizations.

The overall goal of the Heart Failure Home Care clinical trial was to determine if a heart failure disease management program utilizing a computer-based telephonic system for home monitoring, in addition to targeted and consistent physician/patient education, coupled with diligent efforts to utilize optimal medical therapy, would be successful in improving outcomes.

One unique aspect of this trial was that it assessed the utility of the sophisticated heart failure monitoring system in a real world setting rather than within the confines of an academic medical center, said Dr. Soran.

This study also was able to assess a large percentage of women. Conversely, patients with other heart failure telemonitoring settings have been predominantly white males recruited by specialists from academic medical centers.

The multi-center trial was conducted at three sites with affiliations at major academic medical centers including UPMC, Case Western Reserve University in Cleveland and Mount Sinai Medical Center in Miami.

In the heart monitoring trial, a total of 315 patients were randomized: 160 to A Day Link Heart Failure Monitoring System and 155 to standard heart failure care. Sixty five percent of patients were predominantly women. Both groups received patient one-on-one education, education to clinicians and an effort to use optimal medical care. In addition, patients randomized to heart failure monitoring system received an electronic scale and an individualized symptom response system linked to a computerized database operated by trained nurses. The primary study endpoint was treatment failure, defined as cardiovascular death or re-hospitalization for heart failure within six months of enrollment. Among patients re-hospitalized for heart failure, length of hospital stay also was considered a primary endpoint.

The study was unable to identify any useful benefits of a home monitoring system over a period of six months of follow-up when comparing outcomes in patients randomized to the home monitoring device to those with standard heart failure care.

Heart failure management programs hold tremendous promise for patients not receiving comprehensive care, but that does not mean that it is universally effective. Further clinical studies are needed to evaluate the effectiveness of enhanced primary care physician and patient education in determining clinical outcomes. Perhaps someday we will be able to better manage patients without including complicated devices if we can diminish the disease with medication and education, added Dr. Soran.

Other collaborators in this study include Ileana L. Pina, M.D., professor of medicine, Case Western Reserve University, Cleveland; Gervasio A. Lamas, M.D., director of cardiovascular research, Mount Sinai Medical Center, Miami; Sheryl F. Kelsey, Ph.D. and Faith M. Selzer, Ph.D., department of epidemiology, and Judith R. Lave, Ph.D., chair, department of Health Policy and Management, all of the Graduate School of Public Health, University of Pittsburgh; John Pilotte, Centers for Medicare and Medicaid Services, Baltimore; and Arthur M. Feldman, M.D., Jefferson Medical College, Philadelphia.

This study was supported by the U.S. Centers for Medicare and Medicaid.

 

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com