Telehealth in adult patients with congestive heart failure in long term home health care: a systematic review

Abstract

Background: Congestive heart failure results in clinical signs of edema, shortness of breath, and decreased quality of life. The effective management of patients with congestive heart failure in long term home care settings is important in reducing rehospitalization, emergency department visits and improving quality of life. Telehealth interventions following hospital discharge in various settings have been reported in the published literature as having an impact on decreasing emergency department visits, rehospitalization and quality of life. The data on its effectiveness with patients in a long term home health agency program however, is limited.

Objective: The purpose of this systematic review was to find and report on the best available evidence related to the effectiveness of telehealth interventions on specific outcomes in adult patients with congestive heart failure in a long term home health care setting.

Search strategy: The search strategy identified both published and unpublished literature in the English language from 1995 to 2010. A range of electronic databases were searched including CINAHL, MEDLINE, EMBASE and COCHRANE.

Inclusion criteria: Adult patients 18 years and older with a diagnosis of congestive heart failure receiving long term care from a home health care agency were considered in this review. Interventions of interest were telemonitoring and telephone follow-up calls with usual care as the comparator. Outcome measures were rehospitalizations rates, emergency department visit rates, and patients' perceived quality of life. Randomized controlled trials and quasi-experimental studies addressing the interventions of interest were selected.

Data collection and analysis: The included studies were evaluated independently by two reviewers for methodological quality using The Joanna Briggs institute appraisal and extraction tools.

Main results: Three randomized controlled trials and two quasi-experimental studies with a total of 612 patients were included in the review. Two randomized controlled trials and one quasi-experimental study evaluated telemonitoring. One quasi-experimental study evaluated structured nursing and telephone visits and the other randomized control trial evaluated in-home visits supplemented by telephone calls. Among the telemonitoring studies only one had a statistically significant reduction in ED 12(26.1%) P =<0.001 and hospital admission rates 13(28.3%) P= <0.001. Two quasi-experimental trials showed improvement in quality of life but in one there was no comparison with the control group. The randomized controlled trial did not evaluate quality of life as an outcome.

Conclusions: The results of this review were equivocal. Only one randomized control trial demonstrated statistically significant results in reducing emergency department visits and hospital readmissions, and the sample size for this study was small.

Implications for practice: The key to improving quality of life and reducing emergency department and rehospitalization rates is to develop interventions that will be effective when implemented into practice.

Implications for research: Research evaluating the role of telehealth in the management of congestive heart failure patients in long term home care agency is in its infancy. There needs to be well designed randomized control trials with larger sample sizes, of longer duration, and appropriately powered to evaluate different interventions.