Postdischarge Noninvasive Telemonitoring and Nurse Telephone Coaching Improve Outcomes in Heart Failure Patients With High Burden of Comorbidity.

Autor: Kimchi A; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California., Aronow HU; Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California., Ni YM; Department of Cardiology, Scripps Memorial Hospital La Jolla, La Jolla, California., Ong MK; Department of Medicine, UCLA, Los Angeles, California., Mirocha J; Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California., Black JT; Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California., Auerbach AD; Department of Medicine, UCSF, San Francisco, California., Ganiats TG; Department of Family Medicine and Public Health, UC San Diego, La Jolla, California., Greenfield S; Department of Medicine, UC Irvine, Irvine, California., Romano PS; Department of Medicine and Pediatrics, UC Davis, Sacramento, California., Kedan I; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: kedani@cshs.org.
Jazyk: angličtina
Zdroj: Journal of cardiac failure [J Card Fail] 2023 May; Vol. 29 (5), pp. 774-783. Date of Electronic Publication: 2022 Dec 13.
DOI: 10.1016/j.cardfail.2022.11.012
Abstrakt: Background: Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) is a promising postdischarge strategy in heart failure (HF). Comorbid conditions and disease burden influence health outcomes in HF, but how comorbidity burden modulates the effectiveness of NTM-NTC is unknown. This study aims to identify patients with HF who may benefit from postdischarge NTM-NTC based on their burden of comorbidity.
Methods and Results: In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to postdischarge NTM-NTC or usual care. In this secondary analysis of 1313 patients with complete data, comorbidity burden was assessed by scoring complication and coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital. Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (≥9) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio 0.25, 95% confidence interval 0.07-0.90) and 180 days (hazard ratio 0.51, 95% confidence interval 0.27-0.98), as well as more days alive (160.1 vs 140.3, P = .029) and days alive out of the hospital (152.0 vs 133.2, P = .044) compared with usual care.
Conclusions: Postdischarge NTM-NTC improved survival among patients with HF with a high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
(Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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