Focus on Heart Failure: Telehome Monitoring Helps Patients Help Themselves

June 8, 2015

Patients admitted to the hospital for heart failure receive a barrage of tests and treatments to assess and stabilize their conditions. But when they are discharged home, much of the responsibility for the patients’ future health rests in their own hands. If they don’t take their medications as prescribed or if they don’t follow diet and fluid instructions (a salty diet can rapidly cause water retention, aggravating a weak heart), they can end up right back in the emergency room. Not only is this disruptive for patients and families, it’s expensive to the health care system: A readmission for heart failure can cost up to $20,000 for a several-day hospital stay.

Since 2005, the Telehome Monitoring program at the University of Ottawa Heart Institute has helped more than 2,000 of these patients help themselves, by providing a suite of home care tools and remote oversight by Heart Institute nurses to detect small lapses in self-care before they turn into big problems. In the process, hospital readmissions for participants have been cut by more than half.

“It’s an intensive, acute intervention,” explained Christine Struthers, advanced practice nurse for Cardiac Telehealth Services, who has managed the program since its inception. At-risk patients are identified before discharge and enrolled in the program. Before leaving the Heart Institute, each participating patient receives an electronic scale, an automated blood pressure cuff, a pocket ECG in some cases, a home monitor that transmits data to the Heart Institute, and training in how to use each device.

Once home, patients use the equipment once a day, as taught, to transmit their vital signs and weight to the Heart Institute. An expert cardiac nurse reviews the data daily and alerts a Heart Institute physician if safe levels in any of the parameters are breached. The nurse will also immediately contact patients to check in on them if any concerns arise and recommend changes in their care routines as needed, including medication and nutrition.

Hospital readmissions for Telehome Monitoring participants have been cut by more than half.

Primary care physicians and families are kept informed and notified of any required changes in medications. Patients stay in the program from one to three months after discharge, depending on the severity of their disease.

The Heart Institute considers patient education a vital component of care (see “Using the Right Tools to Manage Heart Failure“) in heart failure, and all patients get extensive guidance on dietary restrictions, fluid intake, physical activity, weight and blood pressure, and medications before discharge. But there’s a difference between hearing something from a health care practitioner and experiencing it in real life, explained Struthers.

“Home monitoring makes the abstract concept of self-care very real,” she said. “Although we’ve explained to them in the hospital not to eat salt, it’s a whole other thing to adapt that to your home situation and your lifestyle. Patients tell us things like ‘Well, I’d been told I couldn’t eat Chinese food, but I didn’t realize that my weight goes up 3 kilograms in one or two days as a direct result.’” They understand the impact of their food choices in the context of their daily lives.

Due to its success, the nurse-run Telehome Monitoring program has grown substantially. Through an initiative called Cardiac TLC, most hospitals in the Champlain region now have monitoring packages of their own. These community hospitals provide the training in equipment use and data transmission to their patients, with the Heart Institute serving as the central data collection centre and sharing the information with community physicians.

Most recently, through funding from our Patient Alumni association, the Heart Institute has purchased tablets that work with wireless devices to serve as the next generation of equipment for the program. These will eventually eliminate the need to connect cables from the devices to the monitor and will let people who no longer have a landline participate in the program.

Struthers said that the feedback from patients remains overwhelmingly positive as the program closes out its first decade. “It maintains their connection with the Heart Institute after discharge, regardless of where they live. Patients tell us that they love that connection,” said Struthers. “They like being able to speak to a nurse any time and they feel safe at home. That’s something we hear all the time.”