Virtual Heart Function Clinic

Feasibility of remote management via the Internet of patients with heart failure 


Principal Investigator: Scott Lear Co-investigators: Annemarie Kaan, Biljana Maric The Virtual Heart Function Clinic study assesses the feasibility of a website to support self-management and monitoring in heart failure patients. In the seventeen participants who completed the study, a significant change was observed on the maintenance subscale of the Self-Care of Heart Failure Index (p=0.039). Trends toward improvement were also observed in the six-minute walk test, in the Minnesota Living with Heart Failure questionnaire, and in the confidence and management subscale of the Self-Care of Heart Failure Index. This study demonstrated that heart failure patients were willing to use an Internet-based website to monitor their signs and symptoms. More importantly, the website proved to be effective at detecting changes in participants' signs and symptoms and its use is associated with improved self-monitoring skills.

Background

Heart failure results in high rates of mortality and hospital readmission. Patient self-monitoring such as weighing and the monitoring of symptoms, in addition to specialized clinical care has demonstrated improved health outcomes including decreased hospital readmission. Studies investigating specialized devices where patients enter their signs and symptoms, which are monitored by nurses or physicians, have also shown improved outcomes such as an increased quality of life. Such clinics however, may not be accessible to many heart failure patients and the use of such equipment is limited due to high costs. The use of an Internet-based website which does not require additional set-up and which is therefore inexpensive and readily accessible, may be much more optimal for heart failure telemonitoring.

Objectives

The purpose of this study is to investigate the use of a website designed for heart failure monitoring. In particular, the goal of this investigation is to assess the feasibility of a website in supporting self-management and monitoring in heart failure patients, where the monitoring nurse is only alerted when patients indicate a worsening of heart failure signs and/or symptoms.

Methodology

Patients who were newly referred to a Heart Function clinic were screened for eligibility and recruited to participate in the study. Participants were subjected to an initial baseline assessment that included demographics, computer usage and medication use. Participants received care in the Heart Function clinic and access to the heart failure monitoring website which they were trained to use. Participants were asked to log onto the website at a consistent time every day and enter their weight and answer questions related to their heart failure symptoms. The website generated an alert if the participant's weight changed significantly. The monitoring nurse would then follow up with the alert by reinforcing self-monitoring skills, but consulted with clinic nurses to determine appropriate action if the symptoms required appropriate action. Subsequently, functional capacity, self-management skills, and quality of life were assessed. Follow-up assessments were conducted at three and six months. At six months, a semi-structured interview was performed to assess participant uptake of the intervention. Nurses invloved in the intervention were also interviewed.

Results

A significant change in the maintenance sub-scale of the Self-Care of Heart Failure Index were shown in the 17 participants that completed the study. Non-significant trends toward improvement were observed in the six-minute walk test, in the Minnesota Living with Heart Failure questionnaire, and in the confidence and management subscale of the Self-Care of Heart Failure Index. NT-proBNP results of the participants also showed non-significant trends toward improvement while their diastolic blood pressure rates demonstrated a significant change. The interview responses of the participants indicated that the heart failure monitoring website was easy to use and that it made them feel connected to their healthcare professional. On the other hand, the five nurses involved in the intervention felt that the website was useful for patient monitoring, particularly for participants living in remote areas or those who were newly diagnosed.

Conclusion

Taken together with the results of this study, previous comparable studies on the use of websites lend support to the feasibility of an Internet-based website for the monitoring of heart failure patients. The heart monitoring website was not only effective at detecting changes in participants' signs and symptoms, but patients were willing to use it to monitor their signs and symptoms. Further research on the telemonitoring of heart failure should be conducted using a randomized controlled design to assess the advantages of the website over usual care and should examine the outcomes such as quality of life, self-care ability, six-minute walk test and NT-proBNP.

Click here to view the briefing notes for the Virtual Heart Function Clinic study.