利用主动远程患者管理改善农村心脏病学实践中心力衰竭结局的益处：单站点回顾性队列研究。

The Benefits of Using Active Remote Patient Management for Enhanced Heart Failure Outcomes in Rural Cardiology Practice: Single-Site Retrospective Cohort Study.

机构信息

Craig Cardiovascular Center, Seguin, TX, United States.

Craig Cardiovascular Center, San Antonio, TX, United States.

出版信息

J Med Internet Res. 2024 Nov 26;26:e49710. doi: 10.2196/49710.

DOI:10.2196/49710

PMID:39589775

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11632278/

Abstract

BACKGROUND

Rural populations have a disproportionate burden of heart failure (HF) morbidity and mortality, associated with socioeconomic and racial inequities. Multiple randomized controlled trials of remote patient monitoring (RPM) using both direct patient contact and device-based monitoring have been conducted to assess improvement in HF outcomes, with mixed results.

OBJECTIVE

We aimed to assess whether a novel digital health care platform designed to proactively assess and manage patients with HF improved patient outcomes by preventing HF re-exacerbations, thus reducing emergency room visits and HF hospitalizations.

METHODS

This was a single-site, retrospective cohort study using electronic medical record (EMR) data gathered from 2 years prior to RPM initiation and 2 years afterward. In January 2017, this single center began enrolling New York Heart Association (NYHA) class II and class III patients with HF prone to HF exacerbation into an RPM program using the Cordella HF system. By July 2022, 93 total patients had been enrolled in RPM. Of these patients, 87% lived in rural areas. This retrospective review included 40 of the 93 patients enrolled in RPM. These 40 were selected because they had 2 years of established EMR data prior to initiation of RPM and 2 years of post-RPM data; each consented to this Sterling IRB-approved study.

RESULTS

We included 40 patients with at least 4 years of follow-up, including 2 years prior to RPM initiation and 2 years after RPM initiation. In the 2 years after RPM initiation, check-up calls increased 519%, medication change calls increased 519%, and total calls increased by 519%. Emergency room visits for HF fell 93%, heart failure hospitalizations fell 83%, and all other cardiovascular hospitalizations fell 50%. Additionally, the total number of office visits declined by 15% after RPM, and unscheduled or urgent office visits declined by 73%.

CONCLUSIONS

Daily monitoring of trends in vital sign data between engaged patients and a collaborative team of clinicians, incorporated into daily clinical workflow, enhanced patient interactions and allowed timely response or intervention when HF decompensation occurred, resulting in a reduction of outpatient and inpatient clinical use over more than 2 years of follow-up.

摘要

背景

农村人口的心力衰竭（HF）发病率和死亡率负担不成比例，这与社会经济和种族不平等有关。已经进行了多项使用直接患者联系和基于设备的监测的远程患者监测（RPM）的随机对照试验，以评估改善 HF 结局的效果，但结果喜忧参半。

目的

我们旨在评估一种新的数字医疗保健平台，该平台旨在主动评估和管理 HF 患者，是否通过预防 HF 再次恶化来改善患者结局，从而减少急诊室就诊和 HF 住院治疗。

方法

这是一项单站点回顾性队列研究，使用从 RPM 启动前 2 年和启动后 2 年收集的电子病历（EMR）数据。2017 年 1 月，该单一中心开始使用 Cordella HF 系统将易发生 HF 恶化的纽约心脏协会（NYHA）II 级和 III 级 HF 患者纳入 RPM 计划。截至 2022 年 7 月，共有 93 名患者入组 RPM。这些患者中有 87%生活在农村地区。这项回顾性研究包括 93 名入组 RPM 的患者中的 40 名。选择这些患者是因为他们在开始 RPM 前有 2 年的既定 EMR 数据，并且在开始 RPM 后有 2 年的数据；每位患者均同意这项 SterlingIRB 批准的研究。

结果

我们纳入了 40 名至少有 4 年随访的患者，包括 RPM 启动前 2 年和启动后 2 年。在 RPM 启动后的 2 年内，检查电话增加了 519%，药物调整电话增加了 519%，总电话增加了 519%。HF 急诊就诊减少了 93%，HF 住院治疗减少了 83%，所有其他心血管住院治疗减少了 50%。此外，RPM 后门诊就诊次数减少了 15%，非计划或紧急门诊就诊减少了 73%。