Results Summary

What was the research about?

Heart failure occurs when the heart is unable to pump enough blood to the rest of the body. It can often cause admission to the hospital, especially for people 65 or older. Heart failure can lead to frequent hospital visits, poor quality of life, and death.

In this study, the research team wanted to improve care for black and Hispanic adults with heart failure after they leave the hospital. The team compared two groups for three months.

  • Telehealth self-monitoring with a computer system. The team asked patients to use a device to submit their vital signs, including blood pressure and heart rate, every day. A research nurse reviewed this information within three days. Patients also had weekly video calls with the nurse. During these calls, the nurse discussed the vital signs, asked about symptoms, and listened to the patient’s heart and lungs with a digital stethoscope.
  • Clinic outpatient management. Patients received usual care from the hospital or their main heart doctor.

The team looked at how many times patients in each group visited the emergency room and had hospital stays. The team also compared quality of life, anxiety, and depression in the two groups.

What were the results?

During the study, the percentage of patients who went back to the hospital at least once was about the same for the two groups. The average number of times each patient stayed in the hospital for any reason was higher among patients using self-monitoring. However, the number of times patients stayed in the hospital for heart failure or heart disease was about the same for the two groups.

The groups didn’t differ in emergency room visits, quality of life, or depression. Patients who received clinic outpatient management showed greater reduction in anxiety than patients in the telehealth self-monitoring group.

Who was in the study?

The study included 104 adults with heart failure who received care at a hospital in New York that serves people with low incomes. Of these adults, 69 percent were black, and 31 percent were Hispanic. The average age was 60, and 59 percent were men.

What did the research team do?

The research team assigned each patient by chance to one of the two groups. Care for patients in both groups began within one week of patients leaving the hospital and continued for three months. For the next two months, patients using telehealth self-monitoring had a video call with a nurse, while the clinic group received care as usual.

To ask about emergency room visits and hospital stays, a nurse called all patients weekly. The team also looked at medical records for information about these visits and stays. All patients completed a survey about their quality of life at the start and end of the study.

The team worked with a community advisory group during the study. This group included black and Hispanic patients with heart failure, caregivers, patient advocates, and healthcare providers.

What were the limits of the study?

Half of the patients in the telehealth self-monitoring group didn’t submit their vital signs regularly. The self-monitoring program may not have worked well for them for this reason. The study was small and included patients who received care at only one specialized heart failure clinic. Results may differ for people receiving care at other clinics or hospitals.

Future studies could look at ways to encourage patients to submit their vital signs daily.

How can people use the results?

Heart failure clinics could use these study results as they are thinking about how to provide care for black and Hispanic patients with heart failure.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers expressed concern that the report overstated findings related to the superiority of telehealth self-management over comprehensive outpatient management. The report highlighted nonsignificant results trending towards the superiority of telehealth self-management over comprehensive outpatient management, but not the nonsignificant results trending towards comprehensive outpatient management over telehealth self-management. The researchers made extensive revisions in the report to more accurately portray the preponderance of similar outcomes in the two study arms.
  • Reviewers asked why the study used an adherence cutoff of 10 uploads over 90 days, rather than a cutoff that had been used in earlier, similar studies. The researchers explained that they established this cutoff because adherence numbers were low in the study. Stratifying results based on previously established adherence cutoffs would have led to too few outcome events to draw any conclusions about the comparative effectiveness of the two interventions.

Conflict of Interest Disclosures

Project Information

Renee Pekmezaris, PhD
Feinstein Institute for Medical Research
$1,391,753
10.25302/10.2019.AD.13046294
Telehealth Self-Management Program in Older Adults Living with Heart Failure in Health Disparity Communities

Key Dates

September 2013
September 2018
2013
2018

Study Registration Information

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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: January 25, 2023