Telemonitoring of Patients with Implantable Cardiac Devices to Manage Heart Failure: An Evaluation of Tablet-PC-Based Nursing Intervention Program

摘要

Background: With the rapid aging of society, the number of patients with heart failure has also increased. Implantable devices for heart failure have become standardized. Remote monitoring using cardiac devices has grown in popularity for medical efficiency and the early detection of abnormalities. Our first aim was to develop a tablet-PC-based nursing intervention program for patients requiring remote monitoring of implantable cardiac devices. The second purpose was to evaluate the efficacy of the program by using mixed-methods research. Methods: The study consisted of two phases. In phase 1, we designed a tablet-PC-based nursing intervention program, on the basis of a literature review and qualitative data collected via semi-structured interviews. In phase 2, we conducted a randomized controlled trial that served as a preliminary investigation of the program. The outcome measures were readmission, unexpected visits to the clinic for heart problems, quality of life, self-care behavior, and self-efficacy. After the study, we interviewed each participant about his or her experiences with the program. Interviews were audio recorded, coded, and thematically analyzed. Results: The 33 patients with heart failure were randomized into two groups as follows: 17 patients in the telenursing group and 16 in the control group. During 6 months of follow-up, the readmission for heart failure occurred in 11% of the intervention group and 18% of the control group. There were no statistically significant differences between the groups at any outcome measures. Three themes were extracted via qualitative analysis: “getting a sense of safety,” “triggering a health behavior change,” and “feeling like a burden.” Conclusion: No improvements in rates of rehospitalization or unexpected clinic visits were seen in the quantitative study. However, signs of behavior modification were seen in the qualitative study. This program has the possibility of improving patient outcomes.