www.postersession.com

ECG Home Telemonitoring in Patients With Heart Failure

Pace University, College of Health Professions, Lienhard School of Nursing

PICO: For patients ages 65 and older with heart failure, would using home telemonitoring reduce the rate of readmission to the VA Hospital within 30 days, compared to those who did not utilize the telemonitoring service?

BACKGROUND & RATIONALE

●  Heart failure (HF) is defined as the inability of the heart to pump enough blood to meet the body’s demand for oxygen (NIH, 2014).

●  HF resulted in 6.5 million hospital days annually in the USA, and is the most common cause of hospitalization in elderly adults over the age of 65. Hospital admission due to HF is the largest contributor of unexpected readmission costs (Kanenko et al., 2015).

●  Readmission due to HF costed medicare over $1.74 billion in 2011 (Hines et al, 2014).

●  The VA NY Harbor readmission rate within 30 days for patients with HF is above the national average readmission rate of 22.7% (CMS, 2015).

●  Patients with CHF experience multiple barriers that impede their access to healthcare. Barriers include: transportation to the clinic, costs of care, and infirmity (Smith, 2013).

●  Telemonitoring is the use of technology for clinical observation of patients, which allows healthcare professionals to monitor and interpret patients’ data while allowing the patients to remain in the comfort of their homes (Willemse, Adriaenssens, Dilles, & Remmen, 2014).

●  Early detection of HF can decrease costs, hospital readmissions, length of hospitalization, and mortality (Kitsiou, Paré, & Jaana, 2015).

●  Patients discharged home from the VA with HF are supplied with a Cardiocom Commander-Flex monitor, which allows for daily vital signs and health checks, analyzed by VA nurses.

EBP RECOMMENDATIONS

●  Home telemonitoring for patients with CHF including the use of an ECG home monitor, combined with education of heart failure symptoms (Pinkerman et al., 2013).

●  Education about telemonitoring and use of an ECG to begin at the time of admission by the patient’s primary nurse.

●  Education on recognizing signs and symptoms of HF exacerbations should continue for the duration of the hospital stay.

●  Discharge teaching by telemonitoring nurse. ●  Having the patient “teach-back” how to use

equipment needed to monitor blood pressure, heart rate, pulse oximetry, weight, and ECG.

●  Daily structured telephone support by a nurse to monitor signs of HF exacerbations.

EVALUATION ●  After 4 months, evaluate rate of readmission within

30 days for patients with CHF using an ECG monitor to determine the effectiveness of using home ECG telemonitoring.

●  Compare percentage of readmission rates among patients who used ECG telemonitoring with patients who used the current VA telemonitoring system.

●  Ask patients who participate in the program to complete a survey to evaluate ease-of-use, comfort, and how long it takes to complete the daily monitoring. Also, assess for potential barriers to compliance.

Eliyahu Abramowitz Judith Agishtein Miriam Becher Naomi Farkas Robert Ober

Yaakov Perlstein

SEARCH STRATEGY

●  Databases searched included the following: CINAHL, Cochrane, Google Scholar, NIH, and PubMed.

●  Keywords included: congestive heart failure, heart failure, ECG home monitoring, interventions, readmissions, telemonitoring, telemedicine.

●  Delimitations included: English language only, publication date of 2010 and after, scholarly systematic reviews, and research articles.

●  Based on the relevance to our PICO question, the amount of evidence, and level of effectiveness, 12 articles were used including: two systematic reviews, one clinical guidelines, and a randomized control trial.

LITERATURE REVIEW

●  Telemonitoring of patients at home helps increase early recognition of heart failure exacerbation so that appropriate intervention are implemented in a timely manner, which leads to less hospitalizations (Kitsiou et al., 2015; Smith, 2013).

●  Network meta-analysis found that patients who received telemedicine interventions that involved the use of ECG data transmission were hospitalized less than patients who received usual care, and had reduced mortality rates and fewer hospitalizations (Antonicelli, Mazzanti, Abbatecola, & Parati, 2010; Kitsiou et al., 2015; Kotb, Cameron, Hsieh & Wells, 2015).

●  Cardiac arrhythmias, palpitations of unknown causes, the outcome of antiarrhythmic drug therapy, or interventional ablation therapy can be assessed using ECG telemonitoring (Mateev, Simova, Katova, & Dimitrov, 2012).

●  Telemonitoring, or nurse administered telephone based management programs were clinically effective in patients with chronic HF in comparison to the usual care methods (Antonicelli et al., 2010).

METHOD FOR IMPLEMENTATION ●  Educate the VA NY Harbor nurses about the

benefits of telemonitoring, and about the technology used for telemonitoring.

●  Create a coalition of diverse healthcare professionals to advocate the use of ECG telemonitoring for patients with HF, and educate healthcare professionals and patients about the benefits of ECG telemonitoring.

●  Primary nurse begins educating each patient with CHF about signs and symptoms of exacerbations of HF.

●  Assess patients ability and teach patient how to use equipment to monitor blood pressure, heart rate, pulse oximetry and weight daily.

●  Teach patient how to use an ECG telemonitor. ●  Instruct patient to contact telemonitoring nurse and

primary care physician with any signs of worsening heart failure after discharge to prevent readmission to the hospital.

●  Collect data on patients’ use of telemonitoring service and ECG use.

http://thecaringmission.nurelm.com/services.jsp?pageId=2161392240601321021484523

http://thecaringmission.nurelm.com/services.jsp?pageId=2161392240601321021484523

REFERENCES

Antonicelli, R., Mazzanti, I., Abbatecola, A. M., & Parati, G. (2010). Impact of home patient telemonitoring on use of beta-Blockers in congestive heart failure. Drugs & Aging. 27(10). pp. 801-805. Level II: Randomized Control Trial

Center for Medicare Service. (2015 ). Hospital Compare. Medicare.gov. Retrieved April, 15 2015 from http://www.medicare.gov/hospitalcompare/profile.html#profTab=3&ID=33017F&loc=10004&lat=40.7038704&lng=-74.0138541&name=VA Level VII: Report of Expert committee

Hickey, K. T., Reiffel, J., Sciacca, R. R., Whang, W., Biviano, A., Baumeister, M., & ... Garan, H. (2010). The Utility of Ambulatory Electrocardiographic Monitoring for Detecting Silent Arrhythmias and Clarifying Symptom Mechanism in an Urban Elderly Population with Heart Failure and Hypertension: Clinical Implications. JAFIB: Journal Of Atrial Fibrillation, 663-674. Level III: Control Trial Without Randomization.

Hines A.L., Barrett M.L., Jiang H.J., Steiner C.A. (2014) Conditions With the Largest Number of Adult Hospital Readmissions by Payer. HCUP Statistical Brief #172, April 2014. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved April, 20 2015 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf.

Kaneko, H., Suzuki, S., Goto, M., Arita, T., Yuzawa, Y., Yagi, N., & ... Yamashita, T. (2015). Incidence and predictors of rehospitalization of acute heart failure patients. International Heart Journal, 56(2), 219-225. doi:10.1536/ihj.14-290 Level IV: Cohort Study

Kitsiou, S., Paré, G., & Jaana, M. (2015). Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews. Journal Of Medical Internet Research, 17(3), e63. Level I: Systematic Review

Kotb, A., Cameron, C., Hsieh, S., & Wells, G. (2015). Comparative Effectiveness of Different Forms of Telemedicine for Individuals with Heart Failure (HF): A Systematic Review and Network Meta-Analysis. Plos ONE, 10(2), 1-15. doi:10.1371/journal.pone.0118681 Level I: Systematic Review

Mateev, H., Simova, I., Katova, T., & Dimitrov, N. (2012). Clinical Evaluation of a Mobile Heart Rhythm Telemonitoring System. ISRN Cardiology, 1-8. doi:10.5402/2012/192670 Level III: Control Trial Without Randomization

National Institutes of Health. (2014). What Is Heart Failure?. Retrieved April 20, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/hf Level VII: Report of Expert Committee

Smith, A. C. (2013). Effect of Telemonitoring on Re-Admission in Patients with Congestive Heart Failure. MEDSURG Nursing, 22(1), 39-44. Level VII: Opinion of Authorities

Pinkerman, C., Sander, P., Breeding, J. E., Brink, D., Curtis, R., Hayes, R., . . . Turner, A. (2013). Heart failure in adults. Institute for Clinical Improvement: retrieved from https://www.icsi.org/_asset/50qb52/HeartFailure.pdf. Level I: EPB Guidelines

Willemse, E., Adriaenssens, J., Dilles, T., & Remmen, R. (2014). Do telemonitoring projects of heart failure fit the Chronic Care Model?. International Journal Of Integrated Care (IJIC), 141-11. Level VI: Qualitative Study