Introduction: A telehealth care management program was evaluated for affects on quality of life (QoL) and patient activation in a post-acute heart failure rural population.
Hypothesis: A telehealth heart failure program can improve patient quality of life after hospitalization with acute heart failure.
Methods: A prospective, single-arm, quality improvement program evaluating the expansion of a transitional care program into rural areas was performed. Following discharge for HF admission, patients were enrolled in a telehealth HF monitoring program (Medtronic Care Management Services) which consisted of daily weight and symptom questions transmitted via telehealth technology for evaluation by a site HF nurse. Subjects were identified as either living in a medically underserved area (MUA) or non-MUA. QoL assessment and patient activation, a measure of engagement and confidence in disease self-care, were evaluated at baseline and 9 months using the Minnesota Living with Heart Failure Questionnaire (MLWHF) and PAM-13, respectively.
Results: 197 HF patients (101 males (51.3%), average age 70.1±13.7 years) were followed for 9 months after a HF discharge. The readmission rate was 10.2%, 23.0%, and 29.9% at 30, 60, and 90 days post-discharge, respectively, compared to Illinois state rates of the same time period which were 17.8%, 27.5%, and 34.53% for 30, 60, and 90 days post-discharge. There was no difference in readmission rate between medically underserved (MUA) and non-MUA groups. At baseline, i.e., within one week of discharge, the average MLWHF score was 55.2±24.0, whereas at follow-up scores had improved to 29.5±21.9, a significant decrease (p<0.001). PAM were also evaluated, with 74.7% (n=139) of patients having Level 3 and 4 PAM at baseline. Between groups, there were no differences for either readmission or MLWHF at baseline per PAM levels; however, PAM levels of 3 or higher were associated with improved QoL at 9 months (p=0.01).
Conclusions: Using telehealth technology to manage HF patients may have contributed to both a lower readmission rate than the Illinois state average, or positive clinical outcomes, and QoL improvement. The improved QoL was more in those patients with a higher overall activation.