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Heart Disease

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Home-based monitoring program reduces hospitalizations and costs for elderly patients with heart failure

Heart failure is affecting a growing number of Americans; 1 of every 10 elderly people is affected, and it affects 1 in 100 in the general population. What's more, 45 percent of elderly heart failure patients who are hospitalized are hospitalized again within 6 months. However, a home-based, low-intensity monitoring program can reduce hospitalizations and cost of care for elderly heart failure patients treated by community physicians, according to a pilot study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00028).

Led by Paul A. Heidenreich, M.D., M.S., of the Veteran Affairs Medical Center, Palo Alto, CA, researchers enrolled 68 elderly patients with heart failure in a community-based monitoring program. The multidisciplinary program used nurses to counsel and educate patients about the signs and symptoms of heart failure, and community doctors provided care. Each day, the at-home patients entered their weight, vital signs, and symptoms in a computer program, and they notified the doctor of any abnormalities. The program also included telephone followup and medication reminders with pagers. The researchers compared the medical claims of these patients to those of a control group of 86 patients with similar medical claims the previous year who were not involved in the monitoring program.

Compared with 1995, 1996 medical claims decreased in the monitored group from $8,500 to $7,500, but claims for patients in the control group more than doubled, from $9,200 to $18,800. There were similar differences for hospitalizations and total hospital days. The researchers estimated the cost of the monitoring program to be less than $200 per patient per month. Given this estimate, the cost per monitored patient per year in 1996 was $9,800, a cost substantially below the mean cost of care for control patients during the same period ($18,800).

More details are in "Effect of a home monitoring system on hospitalization and resource use for patients with heart failure," by Dr. Heidenreich, Christine M. Ruggerio, R.N., M.S.N., and Barry M. Massie, M.D., in the American Heart Journal 138(4), pp. 633-640, 1999.

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