Telemonitoring of Patients with Implantable Cardiac Devices to Manage Heart Failure: An Evaluation of Tablet-PC-Based Nursing Intervention Program

Abstract

Background: With the rapid aging of society, the number of patients with heart failure has also increased. Implantable devices for heart failure have become standardized. Remote monitoring using cardiac devices has grown in popularity for medical efficiency and the early detection of abnormalities. Our first aim was to develop a tablet-PC-based nursing intervention program for patients requiring remote monitoring of implantable cardiac devices. The second purpose was to evaluate the efficacy of the program by using mixed-methods research. Methods: The study consisted of two phases. In phase 1, we designed a tablet-PC-based nursing intervention program, on the basis of a literature review and qualitative data collected via semi-structured interviews. In phase 2, we conducted a randomized controlled trial that served as a preliminary investigation of the program. The outcome measures were readmission, unexpected visits to the clinic for heart problems, quality of life, self-care behavior, and self-efficacy. After the study, we interviewed each participant about his or her experiences with the program. Interviews were audio recorded, coded, and thematically analyzed. Results: The 33 patients with heart failure were randomized into two groups as follows: 17 patients in the telenursing group and 16 in the control group. During 6 months of follow-up, the readmission for heart failure occurred in 11% of the intervention group and 18% of the control group. There were no statistically significant differences between the groups at any outcome measures. Three themes were extracted via qualitative analysis: “getting a sense of safety,” “triggering a health behavior change,” and “feeling like a burden.” Conclusion: No improvements in rates of rehospitalization or unexpected clinic visits were seen in the quantitative study. However, signs of behavior modification were seen in the qualitative study. This program has the possibility of improving patient outcomes.

Share and Cite:

Umeda, A. , Inoue, T. , Takahashi, T. and Wakamatsu, H. (2014) Telemonitoring of Patients with Implantable Cardiac Devices to Manage Heart Failure: An Evaluation of Tablet-PC-Based Nursing Intervention Program. Open Journal of Nursing, 4, 237-250. doi: 10.4236/ojn.2014.44028.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Okura, Y., Ramadan, M.M., Ohno, Y., Mitsuma, W., Tanaka, K., Ito, M., Suzuki, K., Tanabe, N., Kodama, M. and Aizawa, Y. (2008) Impending Epidemic: Future Projection of Heart Failure in Japan to the Year 2055. Circulation Journal, 72, 489-491. http://dx.doi.org/10.1253/circj.72.489
[2] Jeon, Y.H., Kraus, S.G., Jowsey, T. and Glasgow, N.J. (2010) The Experience of Living with Chronic Heart Failure: A Narrative Review of Qualitative Studies. BMC Health Services Research, 10, 77.
http://dx.doi.org/10.1186/1472-6963-10-77
[3] Movsowitz, C. and Mittal, S. (2011) Remote Patient Management Using Implantable Devices. Journal of Interventional Cardiac Electrophysiology, 31, 81-90. http://dx.doi.org/10.1007/s10840-011-9548-2
[4] Oliveira, M., Silva Cunha, P. and da Silva, N. (2013) Remote Monitoring for Follow-Up of Patients with Implantable Cardiac Devices. Revista Portuguesa de Cardiologia, 32, 185-190. http://dx.doi.org/10.1016/j.repc.2012.08.006
[5] Klersy, C., De Silvestri, A., Gabutti, G., Regoli, F. and Auricchio, A. (2009) A Meta-Analysis of Remote Monitoring of Heart Failure Patients. Journal of the American College of Cardiology, 54, 1683-1694.
http://dx.doi.org/10.1016/j.jacc.2009.08.017
[6] Marzegalli, M., Landolina, M., Lunati, M., Perego, G.B., Pappone, A., Guenzati, G., Campana, C., Frigerio, M., Parati, G., Curnis, A., Colangelo, I. and Valsecchi, S. (2009) Design of the Evolution of Management Strategies of Heart Failure Patients with Implantable Defibrillators (EVOLVO) Study to Assess the Ability of Remote Monitoring to Treat and Triage Patients More Effectively. Trials, 10, 42. http://dx.doi.org/10.1186/1745-6215-10-42
[7] Boveda, S., Marijon, E., Jacob, S., Defaye, P., Winter, J.B., Bulava, A., Gras, D., Albenque, J.P., Combes, N., Pavin, D., Delarche, N., Teubl, A., Lambiez, M., Chevalier, P. and Mona Lisa Study Group (2009) Incidence and Prognostic Significance of Sustained Ventricular Tachycardias in Heart Failure Patients Implanted with Biventricular Pacemakers without a Back-Up Defibrillator: Results from the Prospective, Multicentre, Mona Lisa Cohort Study. European Heart Journal, 30, 1237-1244. http://dx.doi.org/10.1093/eurheartj/ehp071
[8] Umeda, A. and Inoue, T. (2012) Descriptive Study of the Life with Remote Monitoring of Heart Devices. Journal of the Ochanomizu Association for Academic Nursing, 7, 30-41.
[9] Kumar, S. and Snocks, H. (2011) Telenursing (Health Informatics). Springer, London.
http://dx.doi.org/10.1007/978-0-85729-529-3
[10] Clark, R.A., Inglis, S.C., McAlister, F.A., Cleland, J.G. and Stewart, S. (2007) Telemonitoring or Structured Telephone Support Programmes for Patients with Chronic Heart Failure: Systematic Review and Meta-Analysis. BMJ, 334, 942.
http://dx.doi.org/10.1136/bmj.39156.536968.55
[11] Kamei, T., Yamamoto, Y., Kajii, F., Nakayama, Y. and Kawakami, C. (2013) Systematic Review and Meta-Analysis of Studies Involving Telehome Monitoring-Based Telenursing for Patients with Chronic Obstructive Pulmonary Disease. Japan Journal of Nursing Science, 10, 180-192. http://dx.doi.org/10.1111/j.1742-7924.2012.00228.x
[12] Polit, D.B. (2011) CT: Nursing Research, North American Edition. Generating and Assessing Evidence for Nursing Practice. 9th Edition, Lippincott Williams & Wilkins, Philadelphia.
[13] Creswell, J.W. and Plano Clark, V.L. (2010) Designing and Conducting Mixed Methods Research. 2nd Edition, SAGE Publications, Inc., Washington DC.
[14] Braun, V. and Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. http://dx.doi.org/10.1191/1478088706qp063oa
[15] Rosenstock, I.M., Strecher, V.J. and Becker, M.H. (1988) Social Learning Theory and the Health Belief Model. Health Education Quarterly, 15, 175-183. http://dx.doi.org/10.1177/109019818801500203
[16] Whellan, D.J., Hasselblad, V., Peterson, E., O’Connor, C.M. and Schulman, K.A. (2005) Meta-Analysis and Review of Heart Failure Disease Management Randomized Controlled Clinical Trials. American Heart Journal, 149, 722-729.
http://dx.doi.org/10.1016/j.ahj.2004.09.023
[17] Eastwood, C.A., Travis, L., Morgenstern, T.T. and Donaho, E.K. (2007) Weight and Symptom Diary for Self-Monitoring in Heart Failure Clinic Patients. Journal of Cardiovascular Nursing, 22, 382-389.
http://dx.doi.org/10.1097/01.JCN.0000287027.49628.a7
[18] Hunt, S.A., Abraham, W.T., Chin, M.H., Feldman, A.M., Francis, G.S., Ganiats, T.G., Jessup, M., Konstam, M.A., Mancini, D.M., Michl, K., Oates, J.A., Rahko, P.S., Silver, M.A., Stevenson, L.W., Yancy, C.W. and American College of Cardiology Foundation; American Heart Association (2009) 2009 Focused Update Incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration with the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology, 53, e1-e90. http://dx.doi.org/10.1016/j.jacc.2008.11.013
[19] The Japanese Circulation Joint Working Group (2011) Guidelines for Treatment of Chronic Heart Failure (JCS 2010).
http://www.j-circ.or.jp/guideline/pdf/JCS2010_matsuzaki_d.pdf
[20] McMurray, J.J., Adamopoulos, S., Anker, S.D., Auricchio, A., Böhm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., Gomez-Sanchez, M.A., Jaarsma, T., Køber, L., Lip, G.Y., Maggioni, A.P., Parkhomenko, A., Pieske, B.M., Popescu, B.A., Rønnevik, P.K., Rutten, F.H., Schwitter, J., Seferovic, P., Stepinska, J., Trindade, P.T., Voors, A.A., Zannad, F., Zeiher, A. and ESC Committee for Practice Guidelines (2012) ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in Collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33, 1787-1847. http://dx.doi.org/10.1093/eurheartj/ehs104
[21] Savard, L.A., Thompson, D.R. and Clark, A.M. (2011) A Meta-Review of Evidence on Heart Failure Disease Management Programs: The Challenges of Describing and Synthesizing Evidence on Complex Interventions. Trials, 12, 194. http://dx.doi.org/10.1186/1745-6215-12-194
[22] Heart Failure Society of America (2006) Educational Modules on Heart Failure.
http://www.hfsa.org/ heart_failure_education_modules.asp
[23] Zelen, M. (1979) A New Design for Randomized Clinical Trials. New England Journal of Medicine, 300, 1242-1245.
http://dx.doi.org/10.1056/NEJM197905313002203
[24] Adamson, J., Cockayne, S., Puffer, S. and Torgerson, D.J. (2006) Review of Randomised Trials Using the Post-Randomised Consent (Zelen’s) Design. Contemporary Clinical Trials, 27, 305-319. http://dx.doi.org/10.1016/j.cct.2005.11.003
[25] Snowden, J.A., Biggs, J.C., Milliken, S.T., Fuller, A., Staniforth, D., Passuello, F., Renwick, J. and Brooks, P.M. (1998) A Randomised, Blinded, Placebo-Controlled, Dose Escalation Study of the Tolerability and Efficacy of Filgrastim for Haemopoietic Stem Cell Mobilisation in Patients with Severe Active Rheumatoid Arthritis. Bone Marrow Transplantation, 22, 1035-1041. http://dx.doi.org/10.1038/sj.bmt.1701486
[26] Torgerson, D. and Torgerson, C. (2010) Designing Randomised Trials in Health, Education and the Social Sciences: An Introduction. Japanese Version, Nippon Hyoron Sha, Tokyo.
[27] Pocock, S.J. (1979) Allocation of Patients to Treatment in Clinical Trials. Biometrics, 35, 183-197.
http://dx.doi.org/10.2307/2529944
[28] Fukuhara, S. and Suzukamo, Y. (2005) Health-Related Quality of Life-SF8 and SF36. Journal of Clinical and Experimental Medicine, 213, 133-136.
[29] Kim, W., Shimada, H. and Sakano, Y. (1996) The Relationship between Self-Efficacy on Health Behavior and Stress Responses in Chronic Disease Patients. Japanese Journal of Psychosomatic Medicine, 36, 499-505.
[30] Jaarsma, T., Strömberg, A., Mårtensson, J. and Dracup, K. (2003) Development and Testing of the European Heart Failure Self-Care Behaviour Scale. European Journal of Heart Failure, 5, 363-370.
http://dx.doi.org/10.1016/S1388-9842(02)00253-2
[31] Kato, N., Ito, N., Kinugawa, K. and Kazuma, K. (2008) Validity and Reliability of the Japanese Version of the European Heart Failure Self-Care Behavior Scale. European Journal of Cardiovascular Nursing, 7, 284-289.
http://dx.doi.org/10.1016/j.ejcnurse.2007.12.005
[32] Chaudhry, S.I., Mattera, J.A., Curtis, J.P., Spertus, J.A., Herrin, J., Lin, Z., Phillips, C.O., Hodshon, B.V., Cooper, L.S. and Krumholz, H.M. (2010) Telemonitoring in Patients with Heart Failure. New England Journal of Medicine, 363, 2301-2309. http://dx.doi.org/10.1056/NEJMoa1010029
[33] Seibert, P.S., Whitmore, T.A., Patterson, C., Parker, P.D., Otto, C., Basom, J., Whitener, N. and Zimmerman, C.G. (2008) Telemedicine Facilitates CHF Home Health Care for Those with Systolic Dysfunction. International Journal of Telemedicine and Applications, 2008, Article ID: 235031. http://dx.doi.org/10.1155/2008/235031
[34] Bocchi, E.A., Cruz, F., Guimarães, G., Pinho Moreira, L.F., Issa, V.S., Ayub Ferreira, S.M., Chizzola, P.R., Souza, G.E., Brandão, S. and Bacal, F. (2008) Long-Term Prospective, Randomized, Controlled Study Using Repetitive Education at Six-Month Intervals and Monitoring for Adherence in Heart Failure Outpatients: The REMADHE Trial. Circulation: Heart Failure, 1, 115-124. http://dx.doi.org/10.1161/CIRCHEARTFAILURE.107.744870
[35] Ramachandran, K., Husain, N., Maikhuri, R., Seth, S., Vij, A., Kumar, M., Srivastava, N., Prabhakaran, D., Airan, B. and Reddy, KS. (2007) Impact of a Comprehensive Telephone-Based Disease Management Programme on Quality-of-Life in Patients with Heart Failure. National Medical Journal of India, 20, 67-73.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.