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.
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.
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DOI：
10.1001/jamainternmed.2015.7712
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发表时间：
2016-03
影响因子：
39
通讯作者：
Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group
中科院分区：
文献类型：
--
作者：
Ong MK;Romano PS;Edgington S;Aronow HU;Auerbach AD;Black JT;De Marco T;Escarce JJ;Evangelista LS;Hanna B;Ganiats TG;Greenberg BH;Greenfield S;Kaplan SH;Kimchi A;Liu H;Lombardo D;Mangione CM;Sadeghi B;Sadeghi B;Sarrafzadeh M;Tong K;Fonarow GC;Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group
目前尚不清楚远程监护方法是否对住院后的心力衰竭(HF)患者有好处。评估使用远程患者监测的护理过渡干预措施在减少因心力衰竭住院的老年人群中180天的再入院时间方面的有效性。我们随机将在2011年10月12日至2013年9月30日期间因心力衰竭住院的1437名患者分为干预组(715名患者)或过渡后心力衰竭(BEAT-HF)研究的常规护理组(722名患者)，并对他们进行了180天的观察。我们研究分析的日期为2014年3月30日至2015年10月1日。背景是加利福尼亚州的6个学术医疗中心。参与者是50岁或50岁以上的住院患者，他们接受了失代偿性心衰的积极治疗。这项干预结合了健康指导、电话和远程监护。远程监护使用电子设备收集关于血压、心率、症状和体重的日常信息。集中注册护士进行远程监护复查、程序化操作和电话通话。主要结果是出院后180天内因任何原因再次入院。次要结果是30天内全原因再入院，30天和180天全原因死亡率，30天和180天生活质量。在1437名参与者中，年龄中值为73岁。总体而言，46.2%(1437人中的664人)是女性，22.0%(1437人中的316人)是非洲裔美国人。干预组和常规护理组在出院180天后因任何原因再次入院的比例没有显著差异，分别为50.8%(363/715)和49.2%(355/722)(调整后的危险比，1.03；95%可信区间，0.88-1.20；P=0.74)。在二次分析中，30天再入院或180天死亡率没有显著差异，但干预组和常规护理组的180天生活质量有显著差异。没有不良反应的报道。在因心力衰竭而住院的患者中，健康指导电话和远程监护相结合并没有减少180天的再入院时间。ClinicalTrials.gov标识：NCT01360203
It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization. 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. 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. 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. 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. 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. Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions. clinicaltrials.gov Identifier: NCT01360203