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Telemed J E Health. 2018 Nov 10. doi: 10.1089/tmj.2018.0219. [Epub ahead of print]

A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure.

Author information

1
1 Department of Medicine, Northwell Health , Manhasset, New York.
2
2 Department of Medicine and Department of Community Health, Zucker School of Medicine , Hempstead, New York.
3
3 Department of Occupational Medicine Epidemiology and Prevention, Northwell Health, Great Neck, New York.
4
4 Department of Biostatistics, The Feinstein Institute of Medical Research , Manhasset, New York.
5
5 Department of Cardiology, Heart Failure Center, Nassau University Medical Center , East Meadow, New York.
6
6 Community Advisory Board , Northwell Health, Manhasset, New York.
7
7 Nursing Department, Queensborough Community College , Bayside, New York.

Abstract

BACKGROUND:

Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days.

METHODS:

This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate.

RESULTS:

Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83-2.27), hospitalization (RR = 0.92, CI = 0.57-1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50-28%; COM = 57-13%; p = 0.05).

CONCLUSIONS:

These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.

KEYWORDS:

cardiology/cardiovascular disease; home health monitoring; telehealth; telemedicine

PMID:
30418101
DOI:
10.1089/tmj.2018.0219

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