Telemedicine Follow-up to Reduce 30-Day Readmissions in Heart Failure Patients

1. Introduction

Heart failure (HF) is a long-term and worsening condition that is a large concern to the global health sector. It results from congestive heart failure, which is when the heart is unable to pump enough blood to supply the body’s demand, so this causes symptoms such as shortness of breath and tiredness accompanied by perceived swelling and shortness of breath. Thus, with more people developing it, especially those of the older generation, heart failure remains one of the biggest reasons for hospitalization and rehospitalization; hence, it exerts pressure on the health care facility. Research by Press and colleagues has pointed out that 25% of patients with heart failure are admitted to hospital within one month of discharge and therefore are at higher health risk and total expenditure to the healthcare facilities. This is important both for the welfare of the patient and for the optimization of the health care facilities.

A major issue in heart failure care delivery is achieving the outcome of not readmitting the patient back to the hospital in this vulnerable period. That is why there is the concept of telemonitoring, as well as telemedicine follow-ups, as telemedicine is becoming a welcome measure in the evolution of the new healthcare systems. Telemedicine has proved to help healthcare providers manage and follow up on patients, controlling any tendency towards relapse, which may result in readmission to the hospital. The focus of this paper will be to come up with an evidence-based practice change from four articles that have been chosen from the homestead. These articles identify the use of telemedicine interventions like telemonitoring and telemedicine follow-ups on heart failure patients as well as early readmissions. Namely, this paper will be aimed at the proposal of implementing telemedicine follow-ups in the treatment of heart failure, which change will be supported by the findings of both quantitative and qualitative research.

2. Review of Literature

This literature review combines primary qualitative and quantitative research information derived from four studies in order to analyze the efficiency of telemedicine and telemonitoring for patients diagnosed with heart failure. These reviews deal with the potentials that telemedicine interventions hold in preventing patients’ early hospital readmissions and clinical effectiveness enhancement.

Quantitative Articles:

1.Xu et al. (2022)

Study Type: Quantitative

Summary: In the present study, Xu et al. (2022) wanted to establish if telemedicine visits can decrease the 30-day readmissions of HF patients during the COVID-19 pandemic. The examined records from 6918 patients in a large health system in North Carolina who were admitted between March 2020 and March 2021. The research further established that patients who received telemedicine follow-up fourteen days after discharge had a lower readmission rate of 15% as compared to the patients who did not receive follow-up, showing 23.1%and those who received in-person follow-ups, showing 19%. Specifically, the authors found no significant differences between the two treatment conditions for hospital readmission rates, of either all-cause or cardiac.

Relevance to PICOT: This study fits in directly within the PICOT question as the study measures the impact of telemedicine visits when compared to face-to-face visits and shows that follow-up through telemedicine has the potential to significantly reduce readmission rates among heart failure patients within thirty days. The present research is directly related to the proposed change in practice, as the results of the study indicate that the implementation of telemedicine yields positive clinical outcomes in relation to patients and decreases the rates of patients’ readmissions.

2.Umeh et al. (2022)

Study Type: Quantitative 

Background: In this particular systematic review and meta-analysis study, Umeh et al. (2022) analyzed 38 RCTs with 14,993 heart failure patients with regard to mortality and hospitalization intensification. According to the meta-analysis, telemonitoring reduced all-cause mortality relative risk (RR = 0.83) and hospitalization (RR = 0.87). The study also established the effectiveness of telemonitoring that continued for at least one year as a better approach to telemonitoring. Despite the reported insignificant changes in the incidence of heart failure hospitalizations, this option focused on the importance of telemonitoring in increasing mortality and reducing admissions. 

Relevance to PICOT: It can be stated that the discussed study supports the body of knowledge concerning the potential of telemonitoring to enhance clinical outcomes, including mortality and hospitalization rates. This information indicates that telemonitoring—and especially long-term—is a valuable approach in better patient management and a decrease in rates of readmission.

Qualitative Articles:

1.Vo et al. (2024)

Study Type: Qualitative 

Summary: Vo et al. (2024) examined the study, which aimed at understanding the experiences of the heart failure patients using a mobile app for remote telemetry. The app provided the patient a platform for entering their daily vital signs and also interacting with the doctors and other caregivers so that the patient can have a dynamic treatment plan. Patients were found to be satisfied with the app, and most of the patient responses stressed the aspect that the app simplified their interactions with healthcare workers. However, some of the responses involved negative aspects like the absence of detailed feedback and technical issues like slow network connection. Nevertheless, the patients expressed more perceived self-efficacy and active participation in the management of the illness. 

Relevance to PICOT: This study presents pertinent information on the contribution of patient involvement to the effectiveness of telemedicine approaches. To enhance the effectiveness of telemedicine in reducing readmissions, the clients ought to be more involved, while the challenges like technological support complications and generic approaches must be eliminated. It brings into focus the fact that the telephone-based telemedicine needs to be friendly for the user and heart failure patients require individualized care for the high-risk condition.

2.Carter et al. (2022)

Study Type: Qualitative 

Summary: Carter et al. (2022) sought to explore patients’ attitudes in regard to home-based care and remote supervision of heart failure patients. The participants’ satisfaction with telemonitoring was high because of its convenience and flexibility; however, inconsistent engagement was observed depending on patients’ adherence to various barriers, including technical issues, lack of individualized communication, and weak assistance for low health literate patients. Patients highlighted that telemedicine interventions should improve key features of communication in order to increase the efficiency of this method. It was also revealed that economically dispersed patients have reservations regarding the use of technologies, and noted the lack of digital access as a chief factor in healthcare disparities.

Relevance to PICOT: This paper underscores the need to put an individualized touch through the coverage of telemedicine and its implementation to enhance the patients’ experiences. It postulates that general feedback and technological opportunities should be used to enhance patients’ sustained attention and rehospitalization avoidance. Such findings would support the rationale of enhancing the development and application of telemedicine to specific heart failure patient needs.

3. Comparison of Outcomes

Therefore, the PICOT question led to the expected scenario that telemedicine follow-up will reduce the 30-day readmissions as opposed to no follow-up or in-person follow-ups. The reviewed studies endorse this hypothesis but indicate some variations in the outcomes of the stated telemedicine intercessions.

The quantitative works of Xu et al. (2022) and Umeh et al. (2022) show that telemedicine follow-ups and telemonitoring decrease the readmission rates while enhancing the clinical outcome. Using the idea from the study depicted by Xu et al. (2022), telemedicine follow-up proved to be effective in reducing the readmission rates since those who received a telemedicine follow-up had a lower readmission chance of 15% compared to the 23.1% of those with no follow-up and 19% of those who received in-person visits. Umeh et al. (2022) also agree with the fact that telemonitoring helps to decrease mortality and hospitalization risks, which form part of readmission trends.

Nonetheless, the qualitative work by Vo et al. (2024) & Carter et al. (2022) supplements this by presenting information on why social engagement is crucial, pointing towards the barriers that patients encounter. Vo et al. (2024) also pointed out actively involving patients as one of the success factors of telemedicine interventions, and Carter et al. (2022) focused on the factors such as the specificity to patient needs and convenience. Such works indicate that although telemedicine has the usefulness to facilitate a decrease in readmissions, it’s only possible when challenges of technology and patient perceptions are addressed to allow the patient to feel encouraged to use the equipment.

4. Proposed Evidence-Based Practice Change

From the literature review, the evidence-based practice change proposed is, telemedicine follow-ups for first degree heart failure clients within two weeks of discharge. This practice change is in vain, with the study done by Xu et al. (2022) establishing that early follow-up through telemedicine is as effective as face-to-face consultations in decreasing the 30-day readmissions. Also, in their study, Umeh et al. (2022) also emphasized that, for a more extended period of monitoring than 12 months, telemonitoring leads to better mortality and hospitalization.

In order to meet this type of change, patients have to be availed of telemedicine plans and remote monitoring applications in the healthcare systems. This will entail training of staffing in order to get used to working with the remote data as well as communicating frequently with the patients. One of the important parts of the implementation is going to be tackling the issues of technology utilization with the patients, such as their concerns with regard to access and ease of LEAN technology. Alleviating communication barriers due to technical constraints as well as improving different approaches to follow-up through telemedicine will be vital in actualizing the success of the intervention.

Such practice will, therefore, require the continued training of the staff and a check on the patients’ progress. Assessments with the patients should be taken regularly in order to understand if the existing monitored intervention effectively addresses their needs and how it makes them feel about the monitoring process. Measures to assess the impact of the change in practice can be done through readmission rates in 30 days, patient satisfaction, and clinical parameters such as rates of hospitalization and mortality.

5. Conclusion

The study findings provide an endorsement of the use of telemedicine and telemonitoring as an effective way of delivering post-discharge management of heart failure patients with a goal of minimizing the 30-day readmissions. Synchronous and asynchronous follow-ups of telemedicine have been reported to have shown better patient’ outcomes, decreased readmission rates, and better care as per the available quantitative and qualitative studies. However, experiences expressed in qualitative studies prove that in order to achieve the full potential of the intervention, common issues like technical issues and lack of customization must be addressed. The intervention practice that has been underscored as appropriate—consisting in the use of telemedicine follow-up visits during the 2 weeks after discharge—has the capacity to enhance patient care as well as reduce the extent of costs expended. If issues with the implementation of telemedicine interventions are well looked into and interventions being conducted are patient-centered and easily accessible, then the benefits of these interventions can be hiked up greatly to improve the management of the heart failure disease, and consequently the rate of readmissions will be lowered.

References

Jocelyn Carter, Karen Donelan, & Anne N. Thorndike. (2022). Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. Journal of Primary Care & Community Health, 13. https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672

Umeh, C. A., Torbela, A., Saigal, S., Kaur, H., Kazourra, S., Gupta, R., & Shah, S. (2022). Telemonitoring in heart failure patients: Systematic review and meta-analysis of randomized controlled trials. World Journal of Cardiology, 14(12), 640. https://pmc.ncbi.nlm.nih.gov/articles/PMC9808028/

Thi Xuan Hanh Vo, Marie-Pascale Pomey, Loyda Jean Charles, Paula A. B. Ribeiro, Stéphanie Béchard, Émilie Rémillard, Shana Grigoletti, John Nguyen, Pascale Lehoux, Emmanuel Marier-Tétrault, & Francois Tournoux. (2024). Patients’ experience using an app for home remote monitoring of heart failure for a university hospital in Quebec, Canada. BMC Digital Health, 2(1), 1–12.

https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4

Xu, H., Granger, B. B., Drake, C. D., Peterson, E. D., & Dupre, M. E. (2022). Effectiveness of telemedicine visits in reducing 30‐day readmissions among patients with heart failure during the COVID‐19 pandemic. Journal of the American Heart Association, 11(7), e023935. https://www.ahajournals.org/doi/10.1161/JAHA.121.023935