This document presents a literature review and proposal for a study to evaluate the effectiveness of home telemonitoring using an ECG monitor in reducing hospital readmission rates among patients aged 65 and older with heart failure. Heart failure results in many hospitalizations and readmissions that cost the healthcare system billions each year. The literature suggests that telemonitoring allows for early detection of exacerbations and improved management of heart failure symptoms, leading to fewer hospitalizations. The proposed study would compare readmission rates over 4 months for heart failure patients who use home ECG telemonitoring versus the standard telemonitoring system, with the hypothesis that ECG telemonitoring would reduce readmission rates.

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ECG Home Telemonitoring in Patients With Heart Failure
Pace University, College of Health Professions, Lienhard School of Nursing
PICO: For patients ages 65 and older with heart failure, would using home telemonitoring reduce the rate
of readmission to the VA Hospital within 30 days, compared to those who did not utilize the telemonitoring service?
BACKGROUND & RATIONALE
● Heart failure (HF) is defined as the inability of the
heart to pump enough blood to meet the body’s
demand for oxygen (NIH, 2014).
● HF resulted in 6.5 million hospital days annually in
the USA, and is the most common cause of
hospitalization in elderly adults over the age of 65.
Hospital admission due to HF is the largest
contributor of unexpected readmission costs
(Kanenko et al., 2015).
● Readmission due to HF costed medicare over
$1.74 billion in 2011 (Hines et al, 2014).
● The VA NY Harbor readmission rate within 30 days
for patients with HF is above the national average
readmission rate of 22.7% (CMS, 2015).
● Patients with CHF experience multiple barriers that
impede their access to healthcare. Barriers
include: transportation to the clinic, costs of care,
and infirmity (Smith, 2013).
● Telemonitoring is the use of technology for clinical
observation of patients, which allows healthcare
professionals to monitor and interpret patients’
data while allowing the patients to remain in the
comfort of their homes (Willemse, Adriaenssens,
Dilles, & Remmen, 2014).
● Early detection of HF can decrease costs, hospital
readmissions, length of hospitalization, and
mortality (Kitsiou, Paré, & Jaana, 2015).
● Patients discharged home from the VA with HF are
supplied with a Cardiocom Commander-Flex
monitor, which allows for daily vital signs and
health checks, analyzed by VA nurses.
EBP RECOMMENDATIONS
● Home telemonitoring for patients with CHF including
the use of an ECG home monitor, combined with
education of heart failure symptoms (Pinkerman et
al., 2013).
● Education about telemonitoring and use of an ECG
to begin at the time of admission by the patient’s
primary nurse.
● Education on recognizing signs and symptoms of HF
exacerbations should continue for the duration of
the hospital stay.
● Discharge teaching by telemonitoring nurse.
● Having the patient “teach-back” how to use
equipment needed to monitor blood pressure, heart
rate, pulse oximetry, weight, and ECG.
● Daily structured telephone support by a nurse to
monitor signs of HF exacerbations.
EVALUATION
● After 4 months, evaluate rate of readmission within
30 days for patients with CHF using an ECG monitor
to determine the effectiveness of using home ECG
telemonitoring.
● Compare percentage of readmission rates among
patients who used ECG telemonitoring with patients
who used the current VA telemonitoring system.
● Ask patients who participate in the program to
complete a survey to evaluate ease-of-use, comfort,
and how long it takes to complete the daily
monitoring. Also, assess for potential barriers to
compliance.
Eliyahu Abramowitz
Judith Agishtein
Miriam Becher
Naomi Farkas
Robert Ober
Yaakov Perlstein
SEARCH STRATEGY
● Databases searched included the following:
CINAHL, Cochrane, Google Scholar, NIH, and
PubMed.
● Keywords included: congestive heart failure, heart
failure, ECG home monitoring, interventions,
readmissions, telemonitoring, telemedicine.
● Delimitations included: English language only,
publication date of 2010 and after, scholarly
systematic reviews, and research articles.
● Based on the relevance to our PICO question, the
amount of evidence, and level of effectiveness, 12
articles were used including: two systematic reviews,
one clinical guidelines, and a randomized control
trial.
LITERATURE REVIEW
● Telemonitoring of patients at home helps increase
early recognition of heart failure exacerbation so that
appropriate intervention are implemented in a timely
manner, which leads to less hospitalizations (Kitsiou
et al., 2015; Smith, 2013).
● Network meta-analysis found that patients who
received telemedicine interventions that involved the
use of ECG data transmission were hospitalized
less than patients who received usual care, and had
reduced mortality rates and fewer hospitalizations
(Antonicelli, Mazzanti, Abbatecola, & Parati, 2010;
Kitsiou et al., 2015; Kotb, Cameron, Hsieh & Wells,
2015).
● Cardiac arrhythmias, palpitations of unknown
causes, the outcome of antiarrhythmic drug therapy,
or interventional ablation therapy can be assessed
using ECG telemonitoring (Mateev, Simova, Katova,
& Dimitrov, 2012).
● Telemonitoring, or nurse administered telephone
based management programs were clinically
effective in patients with chronic HF in comparison to
the usual care methods (Antonicelli et al., 2010).
METHOD FOR IMPLEMENTATION
● Educate the VA NY Harbor nurses about the
benefits of telemonitoring, and about the technology
used for telemonitoring.
● Create a coalition of diverse healthcare
professionals to advocate the use of ECG
telemonitoring for patients with HF, and educate
healthcare professionals and patients about the
benefits of ECG telemonitoring.
● Primary nurse begins educating each patient with
CHF about signs and symptoms of exacerbations of
HF.
● Assess patients ability and teach patient how to use
equipment to monitor blood pressure, heart rate,
pulse oximetry and weight daily.
● Teach patient how to use an ECG telemonitor.
● Instruct patient to contact telemonitoring nurse and
primary care physician with any signs of worsening
heart failure after discharge to prevent readmission
to the hospital.
● Collect data on patients’ use of telemonitoring
service and ECG use.
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