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Medpage Today: Improving HF Treatment After Hospital Discharge: Some Surprising Findings

From Medpage Today: The aging population in the United States has contributed to the increasing number of individuals with heart failure and a subsequent 26% increase in hospitalizations for heart failure. This places a large burden on patients themselves and the healthcare system. Addressing ways to manage patients’ medication, diets and weight management, follow-up care, and counseling on other lifestyle changes in a timely fashion is key to improving heart failure and decreasing admissions secondary to heart failure. Using self-monitoring by patients, incentives for patient adherence, and use of technology for remote monitoring that can be sent directly to electronic health records (EHR) are mechanisms that have been shown to be successful in past studies.

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“Negative studies like this are disappointing but remain useful to guide future work. That work should emphasize making it even easier for clinicians to respond to patient early warnings and also recognize that patients with heart failure often get readmitted for reasons that have nothing to do with heart failure itself. That means that future approaches should reflect more comprehensive vigilance and response for other common conditions and not just target the signs and symptoms of heart failure alone.” – David A. Asch, MD, Perelman School of Medicine, University of Pennsylvania How can remote monitoring and incentivized care improve HF treatment? The Electronic Monitoring of Patients Offers Ways to Enhance Recovery (EMPOWER) trial used knowledge of these past successes “to evaluate whether an automated approach to patient engagement that incorporates behavioral economic principles can reduce readmissions in patients with [heart failure] discharged from the hospital.” David A. Asch, MD, of the Department of Medicine and the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, and the Center for Health Care Innovation, Philadelphia, and colleagues reported on this trial in their article, “Remote monitoring and behavioral economics in managing heart failure in patients discharged from the hospital: a randomized clinical trial,” published in JAMA Internal Medicine. The patients in the trial were 18 to 80 years of age and had 1 of the following: a primary diagnosis of heart failure with either preserved or reduced ejection fraction, a secondary diagnosis of heart failure treated with intravenous diuretics during their inpatient hospitalization, or heart failure in their problem list and had been treated with intravenous diuretics during their hospitalization. There were 2 cohorts in the study: the control cohort received usual care (and did not have any further contact with the study personnel) and the intervention cohort was given a digital scale, an electronic pill bottle (for their diuretic medication), and daily regret lottery incentives (if they adhered to taking their medication and weight measurements). The patients in this arm could also have a support partner to help with adherence. If the patient was not adherent, they and their support partner received automated messages with reminders; if they were still non-adherent, they received a phone call from the staff, followed by a call to their support partner, and if still not compliant, the clinician was notified via the EHR. Read more at Medpage Today.