Start showing your humble bathroom scale a little more respect. More than a tool of torture for the vainly weight-conscious, the lowly scale can prevent trips to the emergency room for many of the nearly 5 million people suffering from congestive heart failure.
The reason: a sudden spike in weight, a sign of fluid buildup, can signal an impending cardiac crisis in time to do something about it. Quick and simple intervention, such as boosting patients' doses of diuretic drugs, may be enough to prevent urgent hospital admissions that can easily run $9,000 a pop. The trick in turning mundane scales into powerful medical tools is to get patients to use them every day and relay the results to their caregivers.
Sounds simple, but many of these patients run into trouble in the first place by straying from straightforward instructions to take their medicines and avoid salty foods.
Several companies have responded to the problem recently by combining scales, computers and telephones into patient-friendly devices that automate the process of collecting data and sending it to medical professionals by telephone or wireless technology.
Besides measuring weight, some of the latest systems employ blood pressure cuffs and simple heart rhythm recorders to capture vital signs and other key cardiac information. One even includes a small screen that lets nurses ask patients simple questions about how they feel.
Beyond building gear, some of the companies provide a central monitoring service that collects the information and alerts patients' doctors or nurses when red flags are raised. A missed measurement or an overnight weight gain of 2 pounds is usually all it takes to prompt a call to a patient's home.
Prices vary, but a monthly fee per patient seems most popular. Depending on the level of service, the tabs range from a bit less than $200 to several hundred dollars per month.
The economic logic is crystal clear. Congestive heart failure is expensive to treat and increasingly common. More than 400,000 new cases are diagnosed annually, making it the fastest growing serious heart condition.
The American Heart Association estimates hospitalization of these patients costs $15 billion annually.
Short of heart transplants, there's no cure, so doctors and patients are left to minimize the effects of the chronic illness.
A little low-tech could go a long way toward managing the disease.
"The idea is to decrease medical resource utilization while increasing the quality of patients' lives," says Mandeep Mehra, M.D., medical director of the heart failure program at Ochsner Foundation Hospital, New Orleans. For good reason, he explains, because most hospitals lose money on heart failure admissions. Medicare reimbursement for the most common heart failure admission is roughly $4,500 but treatment costs are typically twice that amount.
What's more, cardiologists know that once a heart failure patient shows up in the E.R., he or she likely will return-and soon. About a fifth of patients are readmitted within a month, and nearly half wind up back in the hospital within three months, according to some studies.
Mehra's group worked with Brookfield, Wis.-based HomMed to design telemonitoring equipment to attack the problem and has used the device to manage some of its toughest patients.
"So far we've been impressed," he says. After three months in the field the equipment has reduced both E.R. visits and the need for outpatient intervention, including home visits.
"This is one of the few things in life where you save money and deliver more effective care," Mehra says.
HomMed is just taking its product to market, but the company forecasts considerable demand.
"We think it's going to be big enough that we're starting to look for a second manufacturer," says Herschel "Buzz" Peddicord, company president and chief executive officer.
So far most of the interest in the monitoring services has come from insurers and specialty companies that carve out responsibility for managing the care of these tough patients.
But some health systems are also starting to kick the telemonitoring tires.
"Our customer is whoever holds the risk for hospitalization," says Tom Shoup, operations manager of the new clinical ventures unit at Agilent Technologies, based in Palo Alto, Calif. The company's telemonitoring device recently won Food and Drug Administration approval.
Regardless of supplier, telemonitoring has obvious clinical appeal.
"It's a terrific idea," says Elsa Giardina, M.D., a cardiologist and professor of medicine at New York Presbyterian Hospital. Though Giardina hasn't used the products in her practice, she says they would be a welcome ally.
Now that there's a way to monitor these patients efficiently, all that remains is for the companies to elicit the clinical will.
"The most important thing is engaging patients and physicians," says Melissa Prince, president and CEO of Alere Medical, San Francisco, another provider of telemonitoring equipment and support services that's been around for several years.
Patients seem to embrace the help.
"It's my security blanket," says Estelle Taylor, a 91-year-old living in Los Altos Hills, Calif., who has been using the Alere system for several years. "I feel confident (because) I'm being monitored every day."