Early outcomes of a care coordination-enhanced Telehome Care Program for elderly veterans with chronic heart failure

Veterans with chronic heart failure ( HF) are frequently elderly, have numerous comorbid chronic medical illnesses, frequent hospitalizations, and have high rates of cardiovascular events. Within the Veterans Health Administration ( VHA), primary care providers are required to manage the majority of HF patients because access to cardiac specialty care within the VHA may be limited. We designed and implemented a care- coordinated, nurse- directed home telehealth management program for veterans with difficult- to- manage or new onset chronic systolic HF. An in- home telehealth message device was provided to the patient at enrollment, and patients received daily HF- specific education via the nurse coordinator and/ or the device throughout their continuum of care. We collected demographic characteristics, clinical characteristics, and outcome data at the time of enrollment and at nearly 6 months after enrollment. A total of 92 patients were enrolled, with complete data available on 73. The mean patient age was 67 years, the mean left ventricular ejection fraction ( LVEF) was 23%, and nearly all patients ( 99%) were men. After enrollment, significant improvements were found in blood pressure ( 129/ 73 to 119/ 69 mm Hg, p < 0.05), weight ( 196 to 192 pounds, p < 0.01), and shortness of breath rating ( 0 - 10 scale, 4.0 to 2.7, p = 0.02). Average daily doses of fosinopril ( 24 to 35 mg/ d, p < 0.01) and metoprolol ( 84 to 94 mg/ d, p = 0.05) were also improved. The total number of inpatient hospital days were reduced while on the home telehealth program ( from 630 for the previous year to 122 for the duration of the program) with only 31% of the hospitalizations related to HF while on the program. Our nurse- directed, care coordinated home telehealth management program was associated with improved early outcomes in a group of elderly male veterans with chronic HF.