Page 4 Heart Failure Remote Monitoring Evidence From the Retrospective Evaluation of a Real World Remote Monitoring Program
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CCCP is a 4-month home telemonitoring and education program designed to improve self-management
in heart failure patients at risk for hospitalization within the Partners HealthCare network of hospitals.
Participants monitor relevant physiologic parameters (blood pressure, heart rate, weight, and blood
oxygen saturation) and answer questions on heart failure–related symptoms on a touch-screen
computer on a daily basis (Figure 1). The remote monitoring equipment included ViTel Net and devices
approved by the Food and Drug Administration: a UA 767PC Turtle 400 monitor, a Life-Source digital
weight scale, an A&D blood pressure cuff and meter, and a BCI pulse oximeter device (UC-321PBT).
Measurements and responses to symptom questions are transferred securely to a remote monitoring
database where the records are reviewed by telemonitoring nurses. Participants also receive structured
biweekly telephone-based education sessions over an 8-week period. Patient education covered a
variety of topics including diet, physical activity, importance of daily measurements, recognizing
symptoms of disease decompensation, and medication adherence. In addition to the structured
educational sessions, they received “just-in time” teaching, that is, unscheduled education done to
intervene when the remote monitoring nurses observe that measurements fall outside the set baseline
range customized for each participant by their physicians or at the onset of new symptoms.
This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care
Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records
of patients with heart failure receiving care at the Massachusetts General Hospital (MGH). While the
heart failure remote monitoring literature is replete with studies in controlled settings, there is a dearth
of literature reporting on the evaluation of real-world heart failure remote monitoring programs. In
addition, by following up with patients after disenrollment from the CCCP program, this study sheds
some light on the downstream impact of completely taking patients (who have built disease self-efficacy
skills) off remote monitoring programs.
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