CONGESTIVE HEART

FAILURE
TELEMONITORING
By Johanna Sotelo
Azusa Pacific University
GNRS 507
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Picture Credit: iUDAME
 PICOT Question

Is a multidisciplinary team
assessment in clinics better
than telemonitoring patients
from home to decrease the
readmission rates in congestive
heart failure patients?

Picture credit: Daily Nurse

 Background
Heart failure can occur due to any
interference with normal
mechanisms that regulate cardiac
output. 1
Symptoms: 1
fatigue, weight gain, edema,
shortness of breath, and more.
Chronic disease account for 78% of
medical costs in the United States. 2 Picture credit: Barnes Jewish hospital

Congestive Heart failure

readmissions cost estimated to be
70% related to readmissions. 3
 Main Findings
Telemonitoring services decreased readmission
rates related to CHF symptom exacerbations. (3, 4, 5,
6)

Education at discharge reduced rehospitalizations

(4)

Education opportunities increased with

telemonitoring (2, 3, 4)
11% Cost savings and reduction in readmission
rates (5)
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Multidisciplinary teamwork was facilitated,

decreasing rehospitalizations and mortality rates (6)
Need for further research (2, 3, 4, 5, 6)
 Relevance to Nursing Practice
Nurses are capable of titrating
medications for CHF patients
with providers order. (3, 4, 5)

Discharge teaching and follow-up

care demonstrated reduction in
readmission by 61% (4)

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 Study Limitations

Small sample sizes(2, 3, 6)

Unknown cause of death (5, 6)
Varied inclusion criteria (2, 3, 4, 5, 6)

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 Barriers to Implementation
Staff coordination within multidisciplinary
teams (4)
Inadequate staffing, heavy patient loads,
busy telemonitoring nurses (4)
Issues with referrals, unclear discharge
dates, high prescription costs (4)

Picture Credit: Amanda Robertson Art

Picture credit: Sleep Review

Picture credit: WNBF
 Conclusion
There is a need for further research to
find statistical significance in
telemonitoring benefits
Telemonitoring benefits include: faster
identification and decreased
exacerbation of symptoms (3, 4, 5, 6)
Education at discharge (4) and via
telemonitoring has applicability in CHF
patients (2, 3, 5, 6)

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 References
1. Lewis S.L., Dirksen S.R., Heitkemper M.M., Bucher L. & Camera, I.M. (2011). Clinical Companion to Medical Surgical
Nursing. Assessment and Management of Clinical Problems (9th ed.). St. Louis, MO: Mosby Elsevier.
2. Pekmezaris, R., Mitzner, I., Pecinka, K. R., Nouryan, C. N., Lesser, M. L., Siegel, M., . . . Smolich, K. (2012). The
impact of remote patient monitoring (telehealth) upon Medicare beneficiaries with heart failure. Telemedicine and
E-Health, 18(2), 101-108. doi: 10.1089/tmj.2011.0095
3. Eilat-Tsanani, S., Golovner, M., Marcus, O., Dayan, M., Sade, Z., Iktelat, A., Oppenheimer, Y. (2016). Evaluation of
telehealth service for patients with congestive heart failure in the north of Israel. European Journal of
Cardiovascular Nursing, 15(3), e78-e84. doi: 10.1177/1474515115602677
4. Raborn, N. (2012). Preventing avoidable heart failure readmissions: The university hospital experience. Journal of
Clinical Outcomes Management, 19(10), 460-464.
5. Maeng, D. D., Starr, A. E., Tomcavage, J. F., Sciandra, J., Salek, D., & Griffith, D. (2014). Can telemonitoring reduce
hospitalization and cost of care? A health plan's experience in managing patients with heart failure. Population
Health Management, 17(6), 340-344. doi: 10.1089/pop.2013.010
6. Dendale, P., Willekens, K., Hansen, D., Houbrechts, M., De Keulenaer, G., Troisfontaines, P., ... Ector, B. (2012).
Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality
and rehospitalization rates in severe heart failure: The TEMA-HF 1 (telemonitoring in the management of heart
failure) study. European Journal of Heart Failure, 14(3), 333-340. doi: 10.1093/eurjhf/hfr144