Background
Congestive heart failure (CHF) is one of the most common and expensive chronic diseases in the US. Prior studies in CHF remote patient monitoring (RPM) have demonstrated decreased mortality and hospital readmissions. However, studies have not investigated CHF RPM in rural Healthcare Professional Shortage Areas (HPSAs) and the impact of various socioeconomic factors on patient outcomes. This study aims to show that a simplified monitoring program can reduce CHF admissions in rural areas.

Methods
Patients were enrolled from various clinics and data were collected including age, sex, race, highest education level, insurance type, home address, EF, eGFR, the number of guideline-directed medical therapy (GDMT) medications prescribed, diuretic use, weight, and admissions 3 months before enrollment. The RPM team consisting of nurses called patients weekly to record compliance with monitoring, weight, and symptoms. Increases in weight or symptoms prompted urgent evaluation. The primary outcome was the number of all-cause and CHF admissions after enrollment, and the secondary outcome was patient weight.

Results
47 patients were analyzed and resided in 14 counties with 91% of HPSAs designated as “rural.” Mean age was 61.2 years; 18 were female and 29 were male. 19 patients were black and 28 were white. Mean EF was 31% and mean compliance was 83%. The group accounted for 47 all-cause admissions and 25 CHF admissions in the 3 months before monitoring which fell to 15 all-cause and 4 CHF admissions 3 months after. Mean weight decreased from 213.9 to 207.0 pounds (p=0.01) with significant differences in weight reduction for race (p=0.04), patients living <20 miles from WTH (p=0.03), diuretic use (p=0.04), and different GDMT (p=0.02).

Conclusion
The results show a promising reduction in admissions in monitored patients, and 72% of patients saw a weight reduction at 3 months. Mean compliance was high at 83% as our study shifted the burden away from patients by employing a nursing team that actively called patients. This study is limited by a small sample size and duration, but patients are continuously enrolled and monitored to increase power. Overall, RPM in rural settings may reduce CHF admissions and improve patient outcomes.

References and Resources

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