Nurse Administered, Telephone Based Disease Management Program for Patients with Heart Failure

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Nurse Administered, Telephone Based Disease Management Program for Patients with Heart Failure Powered By Docstoc
					Telemonitoring for Heart
    Failure Patient
 KM Liu, KF Leung, WK Chan, R Fung,
    TS Chung, NC Chan, KS Chow
 Department of Medicine and Geriatrics
       United Christian Hospital
        Hong Kong SAR, China
           Background
• Heart failure is a common and important
  cause of morbidity and mortality.
• Randomized trials have shown that nurse-
  led care management programs can
  reduce hospitalizations and improve
  symptoms for patients with heart failure.




                      Dunagan WC., et al. J Card Fail.2005 Jun;11(5):358-65
            Purpose:
• To test the feasibility and
  effectiveness of the nurse-
  administered telephone-based
  disease management program (Dial-
  HF program).
                Method
• PATIENTS:
  – Clinical diagnosis of CHF admitted to
    cardiac specialty ward
  – recurrent admissions for heart failure
    exacerbation
  – Exclusion:
    • Significant physical & mental co-morbidity
    • Poor vision, hearing problem and without
      relative support
              Method
• Staff Involved
  - Nurse
  - Cardiologist

• Time
  - From September to March 2006
        Dial- HF program:
•   Individual assessment
•   Case nurse referral
•   Education session by cardiac nurse
•   Structure telephone surveillance,
    and nurse clinic follow up
Case nurse demonstration
The technique for self
     monitoring:
Record in log
           Standard schedule:
                                        *= Telephone FU


    **** **
   * ** ** * ** ** *
            *                       *    *   *    *



Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20…


  After discharge                          = Nurse clinic FU
                Phone Follow up

• Symptom
• Medication

• Nutrition/
  Hydration/
  Elimination
• Activity

+/- Early OPD/
  discuss with
  Cardiologist
     Cardiac Nurse clinic
• HF Symptom

• Promote self care /
  empower self care
  skill

• Medication
  education
   Flexible diuretic dose
• According clinic protocol
   - Features of CCF exacerbation:
     Mild (Adjust loop diuretic as
  prescribed)
     Moderate to severe
   - Contact Cardiac Nurse ( discuss
  with cardiologist arrange admission
  to cardiac ward)
         Method: analysis
•   Patients’ demographics
•   Number of calls by nurse
•   Number of events
•   Actions taken
•   readmission rate
•   mortality rate
            Result(1)
• From September to March 2006
• 50 consecutive patients recruited
• Age: 70.1+/- 22 years (54% of the
  patient were older than 70 years)
• M: F 38:12
• 87% attained primary education or
  less
Education level:
           Result (2)
• 27.5% pt have recurrent admissions
  for heart failure exacerbation in
  previous 1 year
• Average 2.7 times recurrence
  admission in pervious year
• Average length of stay 8.4 days
             Result (3)
• 311 calls (287 scheduled and 24 ad hoc
  phone calls)
• Seven events were detected. 1 event with
  asymptomatic hypotension. 6 events with
  increase in weight
    - adjustment of drug dosages
    - early specialist out-patient clinic
  follow-up.
• Average length of stay decrease to 6.8
  days
      Result (4): up to day
• From September to March 2006
• Unplanned readmission 5 patient event
  - 1 for heart valve problem
  - 1 pt for poor diet compliant leading to
  readmission 2 times
  - 1 for weight gain
  - 2 for non-cardiac cause
• pt recurrent admissions for heart failure
  exacerbation decrease to 10% within 6
  months
 Result (5):Dial HF program
• 50 patients attended the program
  with encouraging result
  – over 90% of whom compliance for daily
    weight measurement
  – No mortality was found for this group of
    patients
          Conclusions
• Nurse-administered telephone-based
  heart failure management program
  ( Dial-HF program appears feasible
  and practical
• Longer term follow up of this group
  of patients is required to establish its
  effectiveness.

				
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