Abstract
Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent communication is an important component of care. A variety of studies using the telephone to maintain communication have demonstrated reduced hospital admissions and improved morbidity rate. Hardware monitoring systems that can record vital signs and transmit information from the home to a data center have also demonstrated their value in HF care, but such systems become expensive when considered for large populations of HF patients. Most HF patients can transmit their vital signs, weight, and symptoms to a practice data center using the Internet with no specialized hardware other than a sphygmomanometer and a scale. We have used such a system to monitor HF patients and have provided care instructions using the same system. With use of an Internet communication system, it is possible to reduce hospitalizations and maintain a stable HF status without frequent office visits.
Similar content being viewed by others
References and Recommended Reading
American Heart Association. Heart Disease and Stroke Statistics — 2005 Update. Dallas, TX: American Heart Association; 2005.
McKee PA, Castelli WP, McNamara PM, Kannel WB: The natural history of HF: the Framingham Study. N Engl J Med 1971, 285:1441–1446.
O’Connell JB, Bristow MR: Economic impact of heart failure in the United States. J Hrt Lung Transplant 1999, 13:S107-S112.
Vinson J, Rich M, Sperry J, et al.: Early remission of elderly patients with congestive heart failure. J Am Geriatr Soc 1990, 38:1290–1295.
Kornowski R, Zeeli D, Averbuch M, et al.: Intensive homecare surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure. Am Heart J 1995, 129:762–766.
Cleland JGF, Gemmell I, Khand A, Boddy A: Is the prognosis of heart failure improving? Eur J Heart Fail 1999, 1:229–241.
Krumholtz HM, Parent EM, Tu N, et al.: Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med 1997, 157:99–104.
Brass-Mynderse NJ: Disease management for chronic congestive heart failure. J Cardiovasc Nurs 1996, 11:54–62.
Kashem A, Marble JF, Droogan MT, et al.: Telemedicine monitoring of heart failure patients via the Internet. Telemed J E Health 2005, 2:34, 249.
Schneider N: Benefits of using home telemedicine to manage congestive heart failure. Telemed J E Health 2005, 2:T3A4, 210.
Rich MW, Beckham V, Wittenberg C, et al.: A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995, 333:1190–1194. This is one of the first home care studies to demonstrate a benefit in patients with HF.
Riegel B, Carlson B, Kopp Z, et al.: Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med 2002, 162:705–712.
Chrysogelos E, Gemme D, Shreve P, et al.: Cost savings and improved outcomes of an outpatient heart failure program. J Card Fail 2000, 6:II-6.
Grancelli H, Varini S, Ferrante D, et al., GESICA investigators: Randomized Trial of Telephone Intervention in Chronic Heart Failure (DIAL): study design and preliminary observations. J Card Fail 2003, 9:172–179.
Grancelli H, Ferrante D, Varini S, et al., GESICA investigators: Improvement of treatment compliance explains benefits in telephone intervention on heart failure patients. DIAL trial. Circulation 2003, 108:IV484.
GESICA investigators: Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ 2005, 331:425. This is a large clinical trial that demonstrates the value of telephone surveillance in managing patients with HF.
Galbreath AD, Krasuski R, Smith B, et al.: Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation 2004, 110:3518–3526.
Dunagan WC, Littenberg B, Ewald GA, et al.: Randomized trial of a nurse-administered, telephone-based disease management program for patients with heart failure. J Card Fail 2005, 11:358–365.
DeBusk RF, Miller NH, Parker KM, et al.: Care management for low-risk patients with heart failure: a randomized, controlled trial. Ann Intern Med 2004, 141:606–613.
Moyer-Knox D, Mueller TM, Vuckovic K, et al.: Remote titration of carvedilol for heart failure patients by advanced practice nurses. J Card Fail 2004, 10:219–224.
Cordisco ME, Benjaminovitz A, Hammond K, Mancini D: Use of telemonitoring to decrease the rate of hospitalization in patients with severe congestive heart failure. Am J Cardiol 1999, 84:860–862, A8.
De Lusignan S, Wells S, Johnson P, et al.: Compliance and effectiveness of 1 year’s home telemonitoring. The report of a pilot study of patients with chronic heart failure. Eur J Heart Fail 2001, 3:723–730.
Massie BM, West J, Van Ostaeyen D, Salbalvaro A: A controlled trial of heart failure management programs. J Am Coll Cardiol 2001, 37:1A-648A.
Nanevicz T, Piette J, Zipkin D, et al.: The feasibility of a telecommunications service in support of outpatient congestive heart failure care in a diverse patient population. Congest Heart Fail 2000, 6:140–145.
Benatar D, Bondmass M, Ghitelman J, Avitall B: Outcomes of chronic heart failure. Arch Intern Med 2003, 163:347–352.
Jerant AF, Azari R, Nesbitt TS: Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention. Med Care 2001, 39:1234–1245.
Goldberg LR, Piette JD, Walsh MN, et al., WHARF investigators: Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 2003, 146:705–712. Daily weight transmitted from home to a data monitoring facility resulted in improved outcome in HF patients.
Cleland JG, Louis AA, Rigby AS, et al., TEN-HMS investigators: Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 2005, 45:1654–1664.
Roth A, Kajiloti I, Elkayam I, et al.: Telecardiology for patients with chronic heart failure: the ‘SHL’ experience in Israel. Int J Cardiol 2004, 97:49–55.
Schofield RS, Kline SE, Schmalfuss CM, et al.: Early outcomes of a care coordination-enhanced telehome care program for elderly veterans with chronic heart failure. Telemed J E Health 2005, 11:20–27.
Shah NB, Der E, Ruggerio C, et al.: Prevention of hospitalizations for heart failure with an interactive home monitoring program. Am Heart J 1998, 135:373–378.
Heidenreich PA, Ruggerio CM, Massie BM: Effects of a home monitoring system on hospitalization and resource use for patients with heart failure. Am Heart J 1999, 138:663–640.
Delgado DH, Costigan J, Wu R, Ross HJ: An interactive Internet site for the management of patients with congestive heart failure. Can J Cardiol 2003, 19:1381–1385.
Masucci M, Homko CJ, Santamore WP, et al.: Bridging the digital divide in underserved patients with cardiovascular risk. Telemed J E Health 2006, 12:58–65. This paper demonstrates that an Internet-based telemedicine system can be used successfully by underserved patients with no prior computer experience.
Committee on Quality of Health Care in America: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: Institute of Medicine, National Academy of Sciences; 2001.
National Committee on Vital and Health Statistics: Information for Health: A strategy for Building the National Health Information Infrastructure. Washington, DC: US Department of Health and Human Services; 2001. This report describes the future of medical communications. It is a must read for anyone interested in chronic disease management and telemedicine.
Kaushal R, Bluementhal D, Poon EG, et al.: The costs of a national health information network. Ann Intern Med 2005, 143:165–173.
Scalvini S, Capomolla S, Zanelli E, et al.: Effect of homebased telecardiology on chronic heart failure: costs and outcomes. J Telemed Telecare 2005, 11(Suppl 1):16–18.
Stewart S, Horowitz JD: Specialist nurse management programmes: economic benefits in the management of heart failure. Pharmacoeconomics 2003, 21:225–240.
Goldberg LR: Electronic and telemedicine techniques to manage heart failure. Curr Treat Options Cardiovasc Med 2005, 7:333–338.
Foot DK, Lewis RP, Pearson TA, Beller GA: Demographics and cardiology, 1950-2050. J Am Coll Cardiol 2000, 35:66B-80B.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kashem, A., Cross, R.C., Santamore, W.P. et al. Management of heart failure patients using telemedicine communication systems. Curr Cardiol Rep 8, 171–179 (2006). https://doi.org/10.1007/s11886-006-0030-1
Issue Date:
DOI: https://doi.org/10.1007/s11886-006-0030-1