determine return on investment in heart failure remote monitoring program

Conditions: Heart Failure

Summary: the study will test a hypothesis that the remote monitoring with text and email alerts sent to study subject and optional family/other caregiver (intervention 1) will have a higher return on investment compared to remote monitoring with nurse researcher follow-up telephone communication to study subject (on blue alerts) or study subject's healthcare professional (on red alerts) (intervention 2) and self-monitoring without intervention (control).

the objective of this remote monitoring study is to evaluate return on investment and end-user clinical outcomes associated with the use of self-monitoring peripherals and tablet/smartphone-based welch allyn healthinterlink technology without intervention (control), healthinterlink remote monitoring with text and email alerts sent to study subject and optional family/other caregiver (intervention 1), and healthinterlink remote monitoring with nurse research assistant follow-up telephone communication to study subject (on blue alerts) or study subject's healthcare professional (on red alerts) (intervention 2 added to intervention 1).

Eligibility criteria:
inclusion criteria: * absence of significant vision, hearing, or other communication deficits * english speaking; * capable and willing to give informed consent; * participated in the in-patient heart failure class within the last three months. acceptable candidate for elective, non-emergent, remote monitoring as determined by ordering physician; * living in a private home; * hospital admission for heart failure or decompensation in the previous 12 months * new york heart association (nyha) classes ii-iv, as assigned by the nurse researcher, trained by a cardiologist * cardiac aetiology: ischaemic, idiopathic, hypertensive, or valvular * left ventricular ejection fraction \<40% s an index of systolic dysfunction, combined or not with a left ventricular filling pattern supporting the presence of diastolic dysfunction, according to the american college of cardiology/american heart association guidelines for chronic heart failure. or * nyha class ii-iii who had an ejection fraction \>40% and evidence of diastolic left ventricular dysfunction. * optional subject with a diagnosis of diabetes (indicated by hba1c \>7). exclusion criteria: * currently involved in other investigational clinical trials (unless permission is granted by other study pi); * females who are pregnant, planning to become pregnant within 3 months, or lactating; * requirement for emergent placement other than private home (subject's condition would be compromised if there is a delay in placement). * myocardial infarction, revascularization or implantable cardioverter defibrillator (icd) implantation in the previous 6 months angina or objective myocardial ischaemia requiring future revascularization implanted ventricular or atrial pacemaker (except dual chamber icd pacemakers with good sinus activity); * end-stage heart failure requiring regular inotropic drug infusions; * chronic renal failure requiring dialysis treatment and * unstable angina.

Keywords: telemedicine heart failure home blood pressure monitoring