White Paper: Congestive Heart Failure (CHF)

blood pressure cuffs and meters, heart monitors. IDEAL LIFE BODY MANAGER, IDEAL LIFE BP MANAGER, IDEAL

LIFE GLUCO MANAGER, IDEAL LIFE POD, REALIZING THE VISION OF A BETTER TOMORROW, Leveraging the

Power of Communication, Real time health and wellness information on demand, wireless remote health and wellness

management, and Solutions for better healthcare through advanced communication technology are all proprietary

trademarks of IDEAL LIFE INC. Contents are covered by one issued U.S. patent and one or more U.S. patents pending.

The information disclosed in this document is confidential and proprietary information of IDEAL LIFE INC. The information

is being provided on the assumption that it will be treated confidentially and for the sole purpose of informing clinical

professionals of suggested care practices present in public literature. The information should not be used as care practice

guidelines and health care professionals should use their own professional judgment when treating patients.

Property of: IDEAL LIFE INC.

Congestive Heart Failure (CHF)

Growing Problem - There are approximately

5.3 million people suffering from

congestive heart failure (CHF) in the United States. The lifetime risk of developing heart

failure at the age of 40 is 20%, and approximately 380,000 people above the age of 65

will be diagnosed with CHF annually. While the incidence of heart failure has remained

stable over the past 20 years, an increase in the over 65 year old demographic (attributed

to the aging baby boomer generation) coupled with longer survival rates will give rise to

a far greater number of heart failure patients in the coming years¹.

Incidence of Hospitalization - A great cause for concern has been the increasing

number of patients being hospitalized with CHF. The number of patients with CHF

discharged from the hospital rose from 400,000 in 1979 to over 1 million in 2005².

Furthermore, within 4-6 months after discharge 47% of the patients are likely to be

readmitted³. In 2004, CHF was listed as the underlying cause in 57,120 deaths and it rose

to 284,365 when the total mention of diseases was included⁴. The five year mortality rate

for patients with CHF was 48% from 1996-2000⁵.

Cost - The estimated total of direct and indirect cost of heart failure in the United States

for

2008 is

$34.8 billion with the greatest share being hospitalizations⁶. In the

commercially insured, Medicare and Medicaid populations, the single largest health

expenditure is inpatient utilization (nearly 33% in 2005) with 13.3% of all emergency

department visits associated with a hospital admission. The average cost associated with

a CHF hospitalization is $10,000. While approximately 14% of Medicare beneficiaries

have heart failure, they account for 43% of Medicare spending⁷.

¹ American Heart Association. Heart Disease and Stroke Statistics — 2008 Update. Dallas, Texas:

² American Heart Association. Heart Disease and Stroke Statistics — 2008 Update. Dallas, Texas:

³Sarwat I. Chaudhry, MD; Yongfei Wang, MS; John Concato, MD, MPH; Thomas M. Gill, MD; Harlan M.

Krumholz, MD, SM, Patterns of Weight Change Preceding Hospitalization for Heart Failure, Circulation.

2007;116:1549-1554

⁴ American Heart Association. Heart Disease and Stroke Statistics — 2008 Update. Dallas, Texas:

⁵ Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J,

Yawn BP, Jacobsen SJ. Trends in heart failure incidence and survival in

a community-based population. JAMA. 2004;292:344 -350

⁶ American Heart Association. Heart Disease and Stroke Statistics — 2008 Update. Dallas, Texas:

⁷ Ariel Linden, Dr.P.H., M.S. and Julia Adler-Milstein. Medicare Disease Management in Policy Context,

HealtH Care FinanCing review/Spring 2008/Volume 29, Number 3

Property of: IDEAL LIFE INC.

Current Population Based Interventions - Increases in body weight are associated

with hospitalization for heart failure and begin at least one week before admission. Daily

information about patients’ body weight identifies a high-risk period during which

interventions can be implemented to avert decompensated heart failure⁸. Current

intervention systems use scales and self-reporting via Integrated Voice Response (IVR)

and internet enabled scales. Interdictions come via telephonic notifications (calls by

nurses, etc).

The IDEAL LIFE Solution™ - The IDEAL LIFE CHF program has been successfully

tested and has been shown to decrease readmissions and optimize at-home treatment.

Through the use of a wireless internet enabled scale, combined with the remote IDEAL

LIFE information management platform™ a patient’s weight is immediately

communicated remotely to the CHF automatic data analysis engine. Within seconds of

stepping on a scale, information is logged and analyzed with alerts generated and

communicated in an appropriate manner.

IDEAL LIFE Results - A study was initiated on a population of 417 CHF patients in a

Medicare Special Needs Plan. The patients were divided into two populations. The first

required 217 patients to call a toll free number and enter their daily body weights through

the telephone over an Integrated Voice Response system (IVR). The second group of

200 patients used the IDEAL LIFE CHF program, which required patients to simply step

on an IDEAL LIFE scale that automatically sent weight readings to the IDEAL LIFE

information management platform™ (IL). Intervention calls were made by nurses when

reported weights fell outside medical guidelines (same for both study populations).

Client Retention - In the IVR group, 76 patients dropped out of the study (65%

retention), while only one patient dropped out of the IDEAL LIFE group (99.5%

retention). The IDEAL LIFE solution™ did not require any change in patient

routine daily behavior, a key factor that contributed to the high retention rate.

Reduction in Hospitalizations - In the three months prior to the initiation of the

study, the IVR group exhibited an admission rate of 620 per 1000 and the IL

group exhibited an admission rate of 630 per 1000; all related to CHF. Three

months after enrollment, the IL group displayed a

57% decline in hospital

admissions, or a 27% hospital admission rate; while the IVR group (65% of the

number intended to manage) had a 46% decline in hospital admissions, or a 33%

rate of hospital admissions.

When calculating the numbers of patients intended to manage (IM), it would be

expected that all those not retained on an intervention program would have

exhibited consistent patterns with usual care on an ongoing basis. The differences

for the IM patients groups are further striking: IM IVR patients showed a 31%

decline in admissions with a 43% rate of hospital admissions while the IM IL

⁸ Sarwat I. Chaudhry, MD; Yongfei Wang, MS; John Concato, MD, MPH; Thomas M. Gill, MD; Harlan

M. Krumholz, MD, SM, Patterns of Weight Change Preceding Hospitalization for Heart Failure,

Circulation. 2007;116:1549-1554

Property of: IDEAL LIFE INC.

patients still retained a 57% decline in admissions with a 27% rate of hospital

admissions.

Admissions Review

700

600

500

IVR

IDEAL LIFE

400

300

200

100

Before Enrollment

IM After Enrollment

Time

Patient Retention Rate

Care Method

Patients Enrolled

Patients Dropout

Retention rate

IDEAL LIFE

200

99.5%

IVR

217

65%

Hospital Admission Review

Care Method

Admissions per

Intended to Manage

Intended to

1000 prior to

1000 after

(IM) Admissions

Manage (IM)

enrollment

per 1000

reduction of

Admissions

IDEAL LIFE

630

270

57%

IVR

620

330

430

31%

Property of: IDEAL LIFE INC.

Cost savings - In the chart below, cost savings for the three month program are

provided. On an annualized basis, prior to enrollment in the IDEAL LIFE CHF

program, the cost for total admissions (based on an average cost of $10,000 per

admission⁹) was $1,260,000 per 200 patients. After enrollment in the IDEAL

LIFE CHF program, the cost for total admissions was $540,000 per 200 patients.

During the program, existing staff resources were utilized and when using the

IDEAL LIFE Solution™ there was a realized cost savings of

$636,000.

Implementing the IDEAL LIFE Solution™ resulted in a return of $7.57 for every

dollar invested.

Return on Investment

Hospital

Cost for three

Cost Savings

Return on

Care

Admissions

months

from

from Technology

Investment

Method

for three

(200 patients)

Technology

Implementation

months (200

Implementation

(%)

patients)

(200 patients)

Usual Care

31.5

$315,000

IDEAL

13.5

$135,000

$159,000

54%

$7.57 for

LIFE

every $1

invested

Costs and Savings

IDEAL LIFE cost

Admissions cost

Savings

⁹ Ariel Linden, Dr.P.H., M.S. and Julia Adler-Milstein. Medicare Disease Management in Policy Context,

HealtH Care FinanCing review/Spring 2008/Volume 29, Number 3