Vol. 15 •Issue 6 • Page 31
Home Is Where the Healthiest Heart Is
Research Is Clear: Patient and Family Need to Be Involved
Among the many health conditions representing threats to American public health, few are more severe than congestive heart failure (CHF).
Some five million Americans, or about 2 percent of the U.S. adult population, suffer from CHF, making this syndrome a leading cause of disability and death. In any typical year, 400,000 new cases are diagnosed. And CHF presents some of the highest mortality rates of any known disease or syndrome, with 50 percent of people diagnosed dying within five years.1 CHF also proves undeniably costly to the American health care delivery system: In excess of $10 billion is expended in any given year in the treatment of CHF.2
The good news is that pharmaceutical and surgical advancements bring us closer, with each passing year, to understanding and treating both CHF symptoms and underlying causes.
Within CHF pharmaceutical management, vasodilators have proven effective by opening blood vessels, facilitating blood flow and diminishing the heart’s workload. Diuretics have succeeded in diminishing excess fluid, often common in CHF patients. And inotropics and beta-blockers, also used often in CHF patients, have proven useful in improving the heart’s contractions and efficiency.
Perhaps most importantly, while the availability of heart donors for transplantation is still far beneath the demand, heart transplantation surgery itself has become a more viable option for many CHF patients.
One of the great remaining challenges in CHF management, however, is managing and encouraging lifestyle changes. And when it comes to encouraging compliance with such changes, the value of home health care is increasingly appreciated. With the support of well-managed home care services, CHF patients often improve their lifestyles and clinical compliance in ways that contribute to more positive outcomes.
Recommended lifestyle adjustments in.clude the reduction of physical and emotional stress, the increase of daily activities with planned rest periods, avoidance of temperature extremes, compliance with prescription regimens, monitoring of weight on a daily basis and sometimes the restriction of fluid intake. Dietary adjustments, especially the restriction of sodium intake, are universal recommendations in CHF patients.
The challenge, of course, is that most of these lifestyle adjustments are difficult for even healthy patients, much less those confronting a serious syndrome such as CHF. And while some of these lifestyle recommendations may seem easy enough to patients, experience dictates that they are, in fact, often difficult.
But when this education and compliance monitoring takes place in the context of a rushed physician office appointment, recommendations are sometimes forgotten and compliance is never really directly monitored. Home care, however, affords a more hands-on approach, often ensuring higher compliance rates and associated improved outcomes.
Such compliance rates are essential for the successful management of CHF, and a large percentage of re-hospitalizations stem directly from failed compliance or inadequate case management. According to the Agency for Health Care Policy & Research, 21 percent of such re-hospitalizations stem from failed social support systems, 20 percent from inadequate follow-up, 20 percent from a failure to seek medical attention properly, 18 percent from dietary non-compliance, 15 percent from inadequate discharge planning and 15 percent from pharmacologic non-adherence.1
HOME CARE TELEMEDICINE
Another benefit of home care is the newly emerging opportunities associated with telemedicine, which enables physicians to monitor body weights, blood pressure and other key vital signs from their patient’s home. It’s a valuable service. Because even modest weight gain in CHF patients can be suggestive of CHF complications or clinical deterioration, the ability to monitor a patient’s weight remotely enables the physician to detect such complications or deterioration quickly and to ensure that patients are treated expeditiously.
Studies suggest that such approaches to the daily monitoring of CHF patients are successful, reducing hospitalizations in these patients. The reduction in hospitalizations, in turn, also represents cost savings. For instance, a study conducted by telemedicine vendor between November 1997 and June 1998 found that CHF patients using such tele-monitoring experienced 87 percent reductions in hospitalizations. Based on an average CHF hospitalization cost of $7,000, the results suggest that such approaches to CHF management represent a cost savings of $12,104 per patient per year.2
A similar study conducted March 1996 to March 1997 by a disease management company found similarly impressive results with the use of telephonic patient monitoring: a 60 percent reduction in hospital admissions and a 55 percent reduction in total medical costs.3
The conclusion should be clear: CHF management stems far beyond the offices of cardiologists and the walls of hospitals, as important as those institutions remain. The proper CHF management must include involvement of the patients and their family in a home environment, where most of the life-saving decisions about CHF management inevitably are made.
• References available on request.
Deborah J. Brash is vice president of clinical .management for Gentiva Health Services, a national provider of home health care services and a national distributor of specialty pharmaceuticals.