Telecardiology for patients with chronic heart failure: the 'SHL' experience in Israel

Background: Patients with chronic heart failure characteristically have multiple hospital admissions for symptom control, deleteriously affecting their quality of life and imposing a burden on national healthcare costs. We assessed the effect of a novel transtelephonic monitoring and follow-up program on the admission rate and length of hospital stay as well as changes in their subjectively rated quality of life of patients with chronic heart failure. Methods: This prospective 1-year study was conducted on compliant subscribers to 'SHL', a telecardiological service with >60,000 subscribers, who were admitted greater than or equal to2 times during the previous year for recurrent pulmonary edema or deterioration in heart failure. Their heart rate, blood pressure and body weight measurements were now automatically transmitted daily to 'SHL's data bank and added to stored and updated medical records. A questionnaire survey acquired information on their quality of life. Results: The study cohort included 118 patients, mean age 75 years (range 49-89 years), 65% males, a II-IV class functional capacity and a 25% (range 10-39%) mean ejection fraction. There was a 66% reduction in the total hospitalization days (from 1623 in the year preceding study entry to 558 during the study period, p<0.0001). Although only 38/118 patients were hospitalized, most participants reported a significant subjective improvement in their quality of life. Conclusions: Data are provided to demonstrate that a transtelephonic system allowing primary care at the patient's home can significantly reduce hospitalization rate and length of stay and significantly enhance the quality of life of patients with chronic heart failure. (C) 2003 Elsevier Ireland Ltd. All rights reserved.