Is home monitoring by patients with heart disease and/or hypertension a feasible alternative? According to experts and results of recent studies, there’s actually no place like home for monitoring cardiovascular patients.
In a recent joint scientific statement by the American Heart Association (AHA), American Society of Hypertension (ASH), and Preventive Cardiovascular Nurses Association (PCNA), experts push for more home monitoring programs of hypertension patients.
“Given the amount of accumulated evidence about the value of home blood-pressure monitoring (HBPM), it is time to make HBPM a part of routine management of hypertensive patients, especially those with diabetes, coronary heart disease, chronic kidney disease, substantial nonadherence, or a substantial white-coat effect.”
according Dr Thomas Pickering, who is a member of the scientific committee who write the statement, as quoted by heartwire.
HBPM is recommended to be a routine part of the management of hypertension, be it known or suspected. It is also recommended for those with the so-called “white-coat hypertension” because routine monitoring may detect “masked hypertension” before it becomes critical.
The committee notes that regular use of home monitoring will improve the quality as lower the cost of health care to the 72 million people with some form of hypertension. It urges the reimbursement of HBPM costs by health insurance.
The use of HBPM has gained popularity in recent years as people’s health literacy improved. According to a recent Gallup poll:
- The number of patients monitoring their BP at home has increased steadily over the past 5 years, being 38% in 2000 and 55% in 2005, an increase of 17%.
- The proportion of patients owning a monitor has increased from 49% in 2000 to 64% in 2005.
- Of patients who do not own monitors, 14% said that expense was the reason.
Heart failure patients
According to another study, home monitoring programs of heart failure patients may actually be more beneficial than initially thought, Health Day News reports
110 patients at the Massachusetts General Hospital in Boston were randomly divided into 2 groups. One group of 68 patients received the usual follow-up care for heart failure patients. Another group of 42 patients were monitored remotely while they stayed at home. The patients in the remote care group had remote monitoring equipment attached that measured vital signs such as heart rate, pulse and blood pressure. They also measured their weight daily and answered a questionnaire about their general well-being. When any of the remote care patients show abnormal values, a health care professional makes a house visit to make a proper assessment. The remote care program is called the Connected Cardiac Care program and was conducted by the Center for Connected Health.
After 3 months of follow-up, patients in the remote care group had much lower hospital readmission rates (31%) compared to the control group (38%). The remote care group also had lower incidence of heart-failure related admissions and emergency room visits.
In a future resource post, I will go into detail about different home monitoring programs available.
Pickering TG, Houston-Miller N, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring. Hypertension 2008.