Comprehensive remote patient monitoring and care shows improved outcomes and reduced total cost of care in heart failure patients
In a new analysis of 367 patients, remote monitoring leads to improved clinical outcomes. In a subset of those patients included in an Accountable Care Organization, participation in a comprehensive RPM program shows reduced total cost of care.
More than 6 million people in the United States have heart failure and is the leading cause of hospitalization in people older than 65. Guideline directed medical therapy (GDMT) effectively reduces morbidity and mortality for patients with heart failure. Unfortunately, despite clear recommendations for initiating and titrating GDMT, optimization of GDMT in HF patients nationwide is staggeringly low.
Remote patient monitoring and care greatly enhance the health and lifespan of heart failure patients, while also promoting personal independence, confidence, and a better quality of life.
The findings of a new analysis published in the Journal of Cardiac Failure (JCF) highlight the positive impact of comprehensive remote patient monitoring (RPM) and care on health outcomes and total cost of care for patients with heart failure with reduced ejection fraction (HFrEF). The analysis showed that further adoption of comprehensive RPM and centralized medication titration would help close care gaps, improve outcomes, and reduce cost.
According to Dr. David Feldman, first author on the manuscript and a cardiovascular medicine fellow at Massachusetts General Hospital: "Our usual way of caring for heart failure patients isn't working. We need to consider all options when it comes to maximizing GDMT and helping patients with heart failure live longer, healthier lives. Collaboration with a centralized RPM program to optimize GDMT titration efforts is a necessary and impactful solution to help close heart failure care gaps and improve outcomes at scale."
Positive clinical outcomes
In the analysis of 367 patients, the percentage of patients on ≥50% target dose significantly increased for all pillars of GDMT. There was also a significant increase in the percentage of patients on all 4 pillars of GDMT at follow-up (84 [23%] vs. 26 [7%]; p<0.001).
There was also a significant decrease in patients’ blood pressure (systolic blood pressure -7, diastolic blood pressure -5; p<0.001) and weight (-2.4 lbs; p=0.010), but not heart rate. See exhibit 1.
Included in this analysis were Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF) who were enrolled in a comprehensive RPM program from August 2021 to April 2023. A remote multidisciplinary clinical team monitored patient’s daily vitals measured on a cellular enabled blood pressure cuff, heart rate monitor and weight scale. Virtual clinical visits using standardized clinical protocols were conducted on a regular basis to facilitate guideline directed clinical interventions including symptom, vital and medication optimization.
Reduced total cost of care
Using claims data from an RPM company’s partner Accountable Care Organization (ACO), a cost analysis was completed to assess the impact of enrollment in the program. A total of 70 heart failure patients were enrolled and compared to 42 heart failure patients who were ordered but not enrolled. Although cost increased in both groups, the total cost of care was significantly reduced (52% reduction) among heart failure patients who enrolled in the comprehensive RPM program. Of the $1,076.64 per patient per month reduction in spending, the majority was attributed to reduction in hospital and post hospital discharge spending. See exhibit 2.
This is the first data to support the effect of an end-to-end RPM solution on reducing total and hospital associated cost.
In addition to Feldman, study authors for the JCF publication include David I. Feldman MD MPH, Sarine Babikian PhD, Theodore Feldman MD, Randall Curnow MD MBA, Marat Fudim MD MHS.
Read the complete manuscript published in the Journal of Cardiac Failure here.
