Evaluation of Home Telehealth Following Hospitalization for Heart Failure: A Randomized Trial

A randomized trial was conducted of heart failure patients in a Veterans Administration Hospital setting. Randomization included telephone, videophone, and usual care for follow-up after hospitalization. Outcome measures included readmission rates, quality of life, etc. The intervention using the telephone and videophone resulted in significantly longer time to readmission, but quality-of-life scores for all participants were higher. The use of the videophone did not demonstrate value or benefit over telephone care. Previous studies have found that home-based intervention programs reduce readmission rates for patients with heart failure. Only one previous trial has compared telephone and videophone to traditional care to deliver a home-based heart failure intervention program. The objective of this study was to evaluate the efficacy of a telehealth-facilitated postdischarge support program in reducing resource use in patients with heart failure. Patients at a Midwestern Department of Veterans Affairs Medical Center were randomized to telephone, videophone, or usual care for follow-up care after hospitalization for heart failure exacerbation. Outcome measures included readmission rates; time to first readmission; urgent care clinic visits; survival; and quality of life. The intervention resulted in a significantly longer time to readmission but had no effect on readmission rates or mortality. There were no differences in hospital days or urgent care clinic use. All subjects reported higher disease-specific quality of life scores at 1 year. There was evidence of the value of telephone follow-up, but there was no evidence to support the benefit of videophone care over telephone care. Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost-effective.