Chronic heart failure is a complex condition that contributes to significant challenges, such as hospitalization, disability, and premature death in some patients (Giordano et.al, 2009). Some of the primary causes include coronary artery disease and uncontrolled hypertension, in addition to myocardial infarction, limited functionality of heart valves, arrhythmias, and congenital heart disease (MedlinePlus, 2014). These circumstances require patients to receive the appropriate form of disease management in order to meet their specific needs effectively (Giordano et.al, 2009).
This process is designed to address the condition and to expand clinical outcomes for patients as best as possible (Giordano et.al, 2009). The primary objective of the study by Giordano et.al (2009) sought to determine if a home-based telemanagement (HBT) strategy was sufficient in reducing the number of hospitalizations and related costs as compared to usual care (UC) as is typically adopted, over a period of one year (Giordano et.al, 2009).
The study adopted a multicenter randomized approach and included the participation of 460 patients who were diagnosed with congestive heart failure (CHF) between the ages of 47-67 years (Giordano et.al, 2009). The study divided the patients in half, with 230 patients designed for an HBT program and 230 patients for a UC program, and those in the HBT program were given a portable device with which a nurse could consult with the patient on an interactive basis (Giordano et.al, 2009). Participants in the UC program were given a transfer to their cardiologists and primary care physicians in a usual and customary fashion (Giordano et.al, 2009). The study sought to determine if the HBT program would reduce the number of hospitalizations related to cardiac events over a one-year period (Giordano et.al, 2009).
The study results indicate that 55 patients, or 24 percent of the HBT group, and 83 patients, or 36 percent of the UC group had been readmitted for cardiovascular complications within the year (RR=0.56 at 95% confidence level; 0.38-0.82; p=0.01) (Giordano et.al, 2009). Furthermore, the HBT group readmission rates led to the following results: HR = 0.50 at 95% confidence level; 0.34-0.73; p=0.01) (Giordano et.al, 2009). In addition, the number of hospital readmissions was decreased by 36 percent, with 91 readmissions in the HBT group and 142 in the UC group; furthermore, hemodynamic instability was decreased by 31 percent (101 in the HBT group and 147 in the UC group) (Giordano et.al, 2009).
Heart failure readmissions were identified at 19 percent, or 43 HBT patients, and 32 percent, or 73 UC patients; however, cardiovascular mortality was not significantly different among the two groups (Giordano et.al, 2009). It was also determined that the cost of hospital readmission was lower for the HBT group (843+/- 1733 euros) versus (1298+/-2322) for the UC group (Giordano et.al, 2009).
This study indicates that the application of an HBT program is likely to benefit patients with CHF in comparison to those who receive UC post-hospitalization (Giordano et.al, 2009). This is an important finding because the cost of readmission is a primary focus of cardiovascular care and treatment, particularly for CHF patients. Nonetheless, other studies must also be explored in order to determine if the HBT program is universally effective in addressing these concerns and in determining how to approach this issue for a larger group of patients. The multicenter randomized approach is appropriate, but it requires duplication in a larger patient population in order to determine if its effectiveness is widespread. In addition, cardiovascular mortality must also be evaluated more closely since the study does not clearly indicate that HBT is a primary factor in reducing these instances.