Heart failure (HF) is a chronic illness that is noted for the subtlety of early symptoms. HF is the leading cause of hospital readmissions for persons over 65 years of age necessitating assistance from family caregivers. More than one million hospitalizations cost the United States health care system over $20 billion a year. Interventions designed to decrease hospitalization have the potential to significantly enhance patient and caregiver outcomes and to minimize health care costs. The proposed pilot study will evaluate whether electronic home monitoring (EHM) by an advanced practice nurse (APN) is more effective than usual home care in enhancing patient outcomes and decreasing hospital costs. The primary aim of the proposed study is to determine whether post-discharge monitoring and support through EHM reduces the proportion of readmissions and emergency department visits and increases the time between discharge and readmission for older adults with HF as compared to the present, usual home care program. The secondary aim of the study is to extend the primary analysis by exploring the effects of patient stressors, resources, and caregiver mastery on patient outcomes such as readmissions, depressive symptomatology, quality of life, adherence, and physiological health indicators.
The third aim of the study is to compare the costs post hospital discharge for those older adults with HF receiving EHM with usual home care versus using only usual home care. The proposed study will include 84 HF patients who are at least 65 years of age and their family caregivers. The patient/caregiver dyads will be recruited from an area hospital before discharge to the community. These dyads will be randomly assigned to receive EHM with usual home care or only usual home care. All dyads will receive an initial interview within a week of hospital discharge and 3 months later. If findings of this pilot study are significant, preliminary data will be used in a larger study to assess whether EHM by an APN is as effective as in-home intensive education by APNs for minimizing hospital readmissions and costs for patients with HF.
