Patients with COPD Require More Care than Elderly Heart Failure Patients in a Hospital-based Home Care Setting
The elderly population is rapidly growing, while lifespans also increase. At the same time, the prevalence of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is also expanding.
In Sweden, the prevalence of heart failure among people age 80 or older is currently estimated at 10 percent while the prevalence of COPD is 8 percent among those aged 50—and increases by age.
Exacerbations of their condition without early treatment intervention often land elderly patients with advanced stages of COPD or CHF in the emergency room and/or hospital. CHF patients often are relieved of their condition through a combination of fluid restriction and diuretics, while moderate and severe exacerbation of COPD often is associated with an inflammatory response in the respiratory tract to an infection and demands antibiotics alone or a combination of antibiotics and steroids.
To gauge the effects of patient education and remote-based care technology on outcomes, researchers in Europe recently set about to determine if telemonitoring supported by hospital-based home care (HBHC) could detect exacerbations early and reduce the number of hospitalizations for patients with these conditions.
Researchers said that during the previous 15 years, a growing number of telehealth studies and reviews have included patients with CHF and/or COPD. Some of these studies have shown reduced morbidity and mortality, as well as positive effects on exacerbation and hospitalizations. However, to become successful, the introduction of a new home telemonitoring system in healthcare needs to be accepted by professional caregivers and their patients.
The most common barrier to telehealth tools was that patients had “no interest” and thought that the technology was too complicated. Considering this lack of familiarity to internet use, researchers employed a telemonitoring system—the Health Diary—based on digital pen technology. In a previous pilot study utilizing the digital pen technology, exacerbations of CHF were detected early, treatment was initiated at home by a specialized hospital-based home care unit, and hospitalization was avoided. In fact, none of the included subjects were hospitalized during the surveillance period of 13 months.
Considering the disease characteristics of CHF and COPD, researchers hypothesized that subjects in an HBHC setting of fragile, elderly patients with advanced stages of CHF or CPOD would exhibit differences regarding exacerbation frequency and subsequent need of healthcare. They set about to determine the healthcare utilization of elderly, sick patients with frequent hospitalizations, and which condition might dominate the need for care.
Additionally, patients with the most advanced form of COPD commonly present with right-heart failure. Primary outcome was exacerbation frequency and home healthcare contacts appearing during the intervention, thus, comparing COPD and CHF subjects. Secondary outcome was the number of hospitalizations during a one-year intervention, compared to the number of hospitalizations of the same subjects the one-year prior inclusion.
The causes behind hospitalization, whether urgent or planned, were of interest, as were the subjects’ experiences handling the technology, their participation in their own care, and heir knowledge of the illness and their feelings of security. Ninety-four patients with advanced diseases were enrolled (36 COPD and 58 CHF subjects) of which 53 subjects (19 COPD and 34 CHF subjects) completed the one-year study period. Death was the major reason for not finalizing the study. Compared to the one-year prior inclusion, the telehealth intervention significantly reduced hospitalization. Although COPD subjects were younger with less comorbidity, exacerbations and HBHC contacts were significantly greater in this group.
Thus, COPD subjects exhibit exacerbations more frequently, mainly because of disease characteristics, thus, demanding much more HBHC.
