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Randomized Controlled Trial
. 2016 Mar;176(3):310-8.
doi: 10.1001/jamainternmed.2015.7712.

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

Michael K Ong  1 , Patrick S Romano  2 , Sarah Edgington  3 , Harriet U Aronow  4 , Andrew D Auerbach  5 , Jeanne T Black  6 , Teresa De Marco  5 , Jose J Escarce  7 , Lorraine S Evangelista  8 , Barbara Hanna  9 , Theodore G Ganiats  10 , Barry H Greenberg  11 , Sheldon Greenfield  12 , Sherrie H Kaplan  12 , Asher Kimchi  13 , Honghu Liu  14 , Dawn Lombardo  12 , Carol M Mangione  15 , Bahman Sadeghi  3 , Banafsheh Sadeghi  16 , Majid Sarrafzadeh  17 , Kathleen Tong  16 , Gregg C Fonarow  3 ; Better Effectiveness After Transition–Heart Failure (BEAT-HF) Research Group
Affiliations
Randomized Controlled 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

Michael K Ong et al. JAMA Intern Med. 2016 Mar.

Erratum in

  • Error in Text and Table.
    [No authors listed] [No authors listed] JAMA Intern Med. 2016 Apr;176(4):568. doi: 10.1001/jamainternmed.2016.0624. JAMA Intern Med. 2016. PMID: 26974880 Free PMC article. No abstract available.
  • Updated Supplement.
    [No authors listed] [No authors listed] JAMA Intern Med. 2016 Jun 1;176(6):871. doi: 10.1001/jamainternmed.2016.1684. JAMA Intern Med. 2016. PMID: 27089116 No abstract available.

Abstract

Importance: It remains unclear whether telemonitoring approaches provide benefits for patients with heart failure (HF) after hospitalization.

Objective: 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.

Design, setting, and participants: 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.

Interventions: 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.

Main outcomes and measures: 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.

Results: 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.

Conclusions and relevance: Among patients hospitalized for HF, combined health coaching telephone calls and telemonitoring did not reduce 180-day readmissions.

Trial registration: clinicaltrials.gov Identifier: NCT01360203.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr De Marco reported being a consultant to Boston Scientific, Cardiokinetics, and Gambro and reported serving on advisory boards for Otsuka and Bayer. Dr Fonarow reported being a consultant to Amgen, Bayer, Baxter, Medtronic, and Novartis. No other disclosures were reported.

Figures

Figure 1
Figure 1. BEAT-HF CONSORT Flow Diagram
BEAT-HF indicates Better Effectiveness After Transition–Heart Failure; CONSORT, Consolidated Standards of Reporting Trials.
Figure 2
Figure 2. Hazard Ratios for Readmission and Mortality at 30 Days and 180 Days
Dashed lines are for the intervention, and solid lines are for usual care. Adjusted hazard ratios, 95% CIs, and P values are from multivariable Cox proportional hazards regression models for readmission and mortality analyses. Models controlled for age, sex, race/ethnicity, insurance, income, social isolation, comorbidities, year, and quarter of enrollment, with enrollment site controlled for as random effects. A and B, The hazard ratio for 30-day readmission with the intervention is 1.03 (95% CI, 0.83-1.29; P = .77). The adjusted hazard ratio for 30-day readmission with the intervention is 1.01 (95% CI, 0.80-1.28; P = .91). The hazard ratio for 180-day readmission with the intervention is 1.03 (95% CI, 0.89-1.19; P = .73). The adjusted hazard ratio for 180-day readmission with the intervention is 1.03 (95% CI, 0.88-1.20; P = .74). C and D, The hazard ratio for 30-day mortality with the intervention is 0.61 (95% CI, 0.37-1.02; P = .06). The adjusted hazard ratio for 30-day mortality with the intervention is 0.53 (95% CI, 0.31-0.93; P = .03). The hazard ratio for 180-day mortality with the intervention is 0.88 (95% CI, 0.67-1.15; P = .32). The adjusted hazard ratio for 180-day mortality with the intervention is 0.85 (95% CI, 0.64-1.13; P = .26).
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