Heart Failure Outcomes After Discharge Saw No Improvement with Remote Monitoring

David A. Asch, MD

New findings suggest remote monitoring of diuretic adherence and weight change with financial incentives did not reduce hospital readmission or death following hospitalization with heart failure (HF).

These were the main findings of the randomized Electronic Monitoring of Patients Offers Ways to Enhance Recovery (EM-POWER) trial, evaluating whether an automated approach to patient engagement incorporating behavioral economic principles can reduce readmission in patients with HF.

“Success toward this goal may require earlier or deeper patient engagement or expanding engagement to encompass the many non-HF reasons that prompt readmissions of patients with HF,” wrote study author David A. Asch, MD, Center for Health Care Innovation.

The 2-arm pragmatic trial recruited participants between May 2016 and April 2019, with eligibility including age 18 - 80 years and a discharge from 1 of 2 Penn Medicine hospitals in Philadelphia, Pennsylvania with either a primary diagnosis of HF, a secondary diagnosis of HF with intravenous diuretics administered during their inpatient stay, or HF appearing on problem list with intravenous diuretics administered during their hospital stay.

Those randomized to usual care had no further engagement with the study personnel. Individuals randomized to the intervention arm received digital scales, electronic pill bottles to use for diuretic medication, daily regret lottery incentives conditional on the previous day’s adherence to both medication and weight measurement ($1.40 expected daily value).

Further, in the intervention arm, individuals’ weights were assessed against prespecified weight change thresholds of either 1.4 kg in 24 hours or 2.3 kg in 72 hours and integrated into the electronic health record (EHR). Moreover, if diuretic medications were missed for 5 days, study investigators alerted the patient’s clinician through the EHR.

After exclusions of patients initially deemed eligible, a total of 552 patients were randomized to the intervention (n = 272) or usual care (n = 280) cohorts. Data show 290 participants were men (52.5%), 291 patients were Black (52.7%), and 231 were White (41.8%), while the mean age of participants was 64.5 years.

Investigators observed 423 (230 related to cardiovascular causes) readmissions and 26 deaths in the control group and 377 (206 related to cardiovascular causes) readmissions and 23 deaths in the intervention group. Data show 178 patients in the control group (64%) and 171 patients in the intervention group (63%) had at least 1 event.

No significant differences between the 2 groups for the combined outcome of all-cause inpatient readmission or death (unadjusted hazard ratio [HR], 0.91; 95% CI, 0.74 - 1.13; P = .40) were found, according to study investigators. They additionally found no statistically significant differences between the 2 groups in all-cause inpatient readmission or death, all-cause inpatient observation stay or death, all-cause cardiovascular readmission or death, and total all-cause death.

Investigators did observe individuals in the intervention group were observed to be slightly more likely to spend fewer days in the hospital (HR, 0.94; 95% CI, 0.90 - 0.99).

“The results suggest that the combination of elements in this intervention when executed at this level of success was insufficient to alter these patients’ trajectories,” Asch concluded.

The study author, “Remote Monitoring and Behavioral Economics in Managing Heart Failure in Patients Discharged From the Hospital,” was published in JAMA Internal Medicine.