ABSTRACT
BACKGROUND: Home care for patients with chronic diseases and specifically with heart failure (HF) is one of the main challenges of health care for the future. Telemedicine, applied to HF, allows intensive home monitoring of the most advanced patients, improving their prognosis and quality of life. The European SmartCare project was carried out in the Friuli Venezia Giulia (FVG) region with the aim of improving integrated health and social care in patients with chronic non-communicable diseases (CNCD) through home telemonitoring (TM) and promoting self-management and patient empowerment. METHODS: The SmartCare project in FVG was a prospective, randomized and controlled cohort study that enrolled, from November 2014 to February 2016, 201 patients in integrated home care ("usual care" [UC] in our study) to TM (n=100) or UC (n=101). Inclusion criteria were age >50 years, at least 1 CNCD (HF, chronic obstructive pulmonary disease, or diabetes) and 1 missing BADL. There were 19 drop-outs (9%) (12 in the TM arm; 7 in the UC arm; p=NS). All patients were followed by a multiprofessional team and stratified in the short-term pathway (3-6 months; average 4 ± 1 months; n=101), enrolled at discharge from hospitalization, or in the long-term pathway (6-12 months; mean 10 ± 3 months; n=100) for frail/chronic patients already followed in home care. RESULTS: The most frequent main diagnosis was HF (n=108, 54%), followed by diabetes (30%) and chronic obstructive pulmonary disease (16%). A Charlson score ≥3 was present in 75% of cases and over 60% were taking at least 7 drugs. Among the social characteristics of the enrolled population, 55% were living alone or with non-familial caregivers, 62% had primary education and 48% were non-self-sufficient. The days of hospitalization were significantly reduced only in the TM arm of the post-acute pathway (20 days of hospitalization avoided for 10 patient-months of follow-up, p=0.03) and the effect was mainly evident in patients with HF (p=0.02). A significant increase in the number of home accesses and telephone contacts were also documented in the TM group (12.7 and 13.7 more home interventions for 10 patient-months of follow-up; p=0.01 and p=0.002 in the post-acute and chronic pathway, respectively). CONCLUSIONS: The SmartCare-FVG project showed in patients with chronic diseases (mainly HF), in the post-acute phase of the disease, to significantly reduce the days of hospitalization with a limited and sustainable increase in the use of nursing home care resources.
Subject(s)
Heart Failure , Telemedicine , Cohort Studies , Heart Failure/therapy , Humans , Middle Aged , Prospective Studies , Quality of LifeABSTRACT
BACKGROUND: The aim of this study was to evaluate the effects of heart failure guideline implementation in the Pordenone province area, by using the regional health system databases. METHODS: We created the provincial registry of hospitalization for heart failure and we defined a set of indicators to assess the adequate use of the hospital facility, the correct use of diagnostic instruments, the appropriate use of medications, the in-hospital, 6-month and 1-year mortality rates. RESULTS: Up to December 31, 2002, 2977 subjects, living in the Pordenone province area, were hospitalized for heart failure (10.4 for 1000 inhabitants). Repeated hospitalizations in the years have percentage values oscillating at around 20%. The average length of hospitalization appeared declining, ranging from 11.1 days in 2000 to 10.3 days in 2002. The in-hospital death rate varied between 16-17%. The cumulative death rate within 6 months (33.2%) and 1 year (41.0%) of hospitalization resulted rather high, also considering the patients' advanced mean age (79 years). The percentage of patients who underwent an echocardiogram as outpatients in the previous year increased from 5.7% in 2000 to 13.1% in 2002. As for therapy, an increase in the percentage of patients treated with ACE-inhibitors (from 44.6 to 50.2%), sartans (from 8.2 to 11.7%), beta-blockers (from 11.7 to 16.7%) and diuretics (from 66.4 to 68.5%) was evident from 2000 to 2001. A mild reduction in the percentage of patients treated with digitalis (from 35.0 to 33.8%) and with calcium antagonists (from 22.4 to 20.9%) was also noted. CONCLUSIONS: The results of this study show that it is possible to use some indicators in evaluating the effects of guideline implementation in heart failure, by using the regional health system data. The final goal is to gradually involve all the professionals in the different phases of the natural course of heart failure patients, particularly the general practitioners.
