Home Monitoring Heart Failure Care Does Not Improve Patient Outcomes

Despite considerable advances in evidence-based medical therapy, heart failure continues to contribute a substantial burden of morbidity, mortality, and economic cost to the American healthcare system. After an admission for heart failure management, nearly 25% of patients are readmitted within 30 days, and by 6 months, this proportion reaches nearly 50%.1,2 Medicare payments for unplanned hospital readmissions totaling more than $17 billion account for nearly 15% to 20% of total Medicare expenditure on acute hospital care.3 Accordingly, in 2009, the US Center of Medicare and Medicaid Services began public reporting of all-cause readmission rates after heart failure hospitalization, and last year, the Patient Protection and Affordable Care Act (PPACA)4 was signed into law, establishing financial incentives for hospitals to reduce cardiovascular readmissions. These trends underscore the growing fiscal and medical imperative to develop better strategies to improve care delivery to heart failure patients and reduce rehospitalization rates.Response by Konstam on p 836Because nearly one half to two thirds of these readmissions appear to be triggered by potentially remediable factors, including poor discharge planning, nonadherence to recommendations regarding diet and medical treatment, inadequate follow-up, poor social supports, and delays in seeking medical attention,5–7 there is increasing interest in restructuring the care of ambulatory heart failure patients to reduce fragmentation, enhance patient self-efficacy, and improve cost-effectiveness, quality, and clinical outcomes while smoothing the transition from hospital to home. Initiatives focused on these goals are broadly categorized as “disease management programs ” and are increasingly endorsed by congressional initiatives to overhaul the U.S. healthcare system, as exemplified by their inclusion as part of the essential health benefits enshrined in section 1302 of the PPACA.4Although heart failure disease management programs vary widely in their specific content and focus, most provide for some …