Structured Telephone Monitoring The basic concept of care extending beyond the health care setting is captured by a simple phone call monitoring strategy wherein patient compliance, symptoms, vital signs, and weight are followed remotely. The DIAL study2-4 was one of the first
to put to trial Structured Telephone Support (STS), with 1,518 HF patients randomized into either a control group or an intervention group that received STS. In the intervention group, dedicated nurses called every 14 days and adjusted the frequency accordingly Inhibitors,research,lifescience,medical thereafter for a year. Predetermined standardized questions were used to assess dyspnea/fatigue, daily weight monitoring, edema progression, dietary and drug therapy compliance, and physical activity. The nurses were only allowed to change the diuretic dose and recommend a nonscheduled medical visit. Nurses Inhibitors,research,lifescience,medical used a computer-aided software system to keep a log of conversations and get reminders for phone calls. All study subjects were followed on a 3-month basis irrespective of the unscheduled visits and phone calls. Most (80%) of these patients had systolic dysfunction and had NYHA class II-III symptoms. Overall, the intervention group had fewer rehospitalizations both in the Inhibitors,research,lifescience,medical short term and at 1–3 years after stopping the
intervention. In a recent meta-analysis, Selleck Selumetinib Inglis et al.5 reviewed 16 studies utilizing STS and found that there was a nonsignificant trend towards improved Inhibitors,research,lifescience,medical mortality (RR 0.88 [95% CI 0.76–1.01], P = 0.08) and a significant 23% reduction in CHF hospitalizations (RR 0.77 [95% CI 0.68–0.87]). All-cause hospitalizations also were reduced.5 Though there was heterogeneity in the various studies, all STS studies included in this meta-analysis had some form of patient education and monitoring. The specifics of intervention in the context of medication changes were not uniform, and some studies had the intervention led by a pharmacist. Of the 16 studies, 6 had reported improved quality of life
(with Inhibitors,research,lifescience,medical STS) in both overall and physical scores on the Minnesota Living with Heart Failure Questionnaire and the Kansas City Cardiomyopathy Questionnaire. The impact of STS appears to be related to increased patient contact time that reinforces the importance of compliance with medication and diet regimens. new Interestingly, counterintuitive to logic, the intensity of home monitoring utilizing STS did not seem to make a difference in the outcome. In the COACH trial,6 moderate and intensive nursing support after hospital discharge made no significant difference in death and all-cause hospitalization, while in the TEN-HMS study,7 STS was as effective as a more intensive and sophisticated monitoring intervention. Of note, both interventions did better than standard of care in this study.