As the evolution of Canada’s healthcare system continues, an increasing number of Canadians are surviving heart attacks and other acute cardiac conditions, consequently increasing their susceptibility to developing chronic heart failure, as reported by the Heart and Stroke Foundation. At present, there is no cure for the illness, and symptoms can be unpredictable, resulting in frequent visits to the hospital emergency department (ED) for many patients.
The Heart and Stroke Foundation highlights the staggering statistics; one in five heart failure patients will be readmitted to the hospital within one month of discharge, and 40% will be readmitted within four months. So, how can a patient’s quality of life be improved?
To help reduce unnecessary ED visits, the Department of Emergency Medicine at the University of British Columbia (UBC) began a randomized controlled trial of home health monitoring (HHM) for heart failure patients: TEC4Home Heart Failure. This four-year initiative, funded by the Canadian Institute of Health Research, the Michael Smith Foundation for Heath Research, the BC Ministry of Health and industry partner TELUS Health, aims to demonstrate the application of technology in Heart Failure patient remote monitoring. TEC4Home is one of many HHM projects across the province that is looking at monitoring heart failure patients. Other HHM projects have included programs around COPD and Diabetes. HHM is currently active across five different health authorities in British Columbia.
Now in phase two, a randomized controlled trial, TEC4Home is recruiting patients from 20 hospital sites across Fraser Health, Interior Health, Providence Healthcare, and Vancouver Coastal Health. Over a 15-month period, the target number of patient participants is 900, which will be split into two groups of 450 — a control group and an intervention group.
Here at the HeartLife Foundation, we were excited to play a role in recruiting patients for the TEC4Home Patient Advisory Committee (PAC). The PAC is comprised of heart failure patients from across BC. This committee provides feedback and guidance to the research team on the patient experience and patient educational materials. We are also working with the research team on a presentation to be given at the upcoming e-Health Conference in May 2019, on the role of patients in research.
How TEC4Home works
The TEC4Home study focuses on the role of home health monitoring in the transition of heart failure patient care from the hospital to the home. Participating patients are given a home health monitoring kit by TELUS Health, which includes a tablet, weight scale, blood pressure cuff, and pulse oximeter to collect biometric measurements daily for 60 days post-hospital discharge. By tracking blood oxygen levels, weight fluctuations, pulse, and blood pressure, patients are educated on the importance of symptom awareness for illness self-management.
Additionally, patients are prompted to answer a series of daily symptomatic questions, recording their answers on the tablet provided. The daily results are reviewed remotely by a monitoring clinician who calls each patient to check-in, prioritizing patients exhibiting abnormal symptoms. Under this care model patients have direct daily clinical input on their condition and can avoid unnecessary readmissions to the ER or other hospitalizations.
The results for phase one, a pilot study involving consecutive patients with Heart Failure from three hospitals including Vancouver General Hospital, St. Paul’s Hospital and Kelowna General Hospital, suggested a “59% reduction for heart failure re-admission, a 44% drop in ER re-visits, a 44% reduction in cost per patient, and 100% improvement in patient self-reported quality of life.” The current 20-community randomized controlled trial will hopefully validate these beneficial effects on a larger scale.
Cardiac patient and participant in the TEC4Home trial, Joy Gaze, describes the home health management program as somebody else looking after her, “it’s like a guardian angel,” she says.
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