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Comparison of Characteristics and Outcomes in Patients with HFpEF and HFrEF: Result From KorAHF Registry
S88 Journal of Cardiac Failure Vol. 22 No. 8S August 2016 home and reduce 30-day all-cause readmissions. While patient-centered care is an aspired to paradigm to focus healthcare where it should be, there is little evidence for a bestpractice strategy to support individual patients during hospitalization and promote understanding and self-efficacy in managing their chronic disease. Our HF Team implemented empathy mapping to learn patients’ subjective perceptions regarding their personal health status and immediate recovery, and facilitate design of an individualized care plan for self-management. Further, analysis of patient responses may demonstrate trends or themes that can drive improvements in care processes. Hypothesis: Patient empathy mapping using a questionnaire administered in a standardized, nonjudgmental way can uncover the experience of care from a patient’s point of view, provide frank feedback on care efficacy, and inform care process redesign that improves patient outcomes and satisfaction. Methods: Hospital-trained volunteers administered a 10-item questionnaire to hospitalized patients with a primary diagnosis of HF. Standardized interview questions were open-ended with follow up queries. Readmitted patients were asked additional questions regarding their perceived reasons for rehospitalization. Responses and basic demographic information were entered into a database and analyzed for actionable follow-up such as adjusted workflows and care transition interventions. Results were presented quarterly to the HF Clinical Effectiveness Council and hospital leadership. Results: Patient responses to post-discharge survey questions assessing satisfaction with their overall hospital experience and feeling prepared to manage selfcare improved by 5%. Comparing baseline 1-year data (476 discharges) to a year post full implementation of our intervention bundle including empathy mapping, overall 30day HF readmissions to our center were reduced by 40% while 90-day readmissions were cut by 25%. Paired t-test analysis validated the significance of these gains (P = .001; P = .01). Conclusion: Incorporating patients’ experience of care into structuring care delivery is key to positive outcomes and fosters patient empowerment. Empathy interviewing provides real-time patient feedback and is easily employed concurrent with care delivery. Patients may disclose their feelings more frankly with impartial volunteers rather than clinical staff. Uncovered defects in communication, in care delivery or unrecognized patient needs may be addressed in individualized plans of care and in aggregate, inform evaluation and redesign of care systems.
254 Evaluating the Role of Palliative Medicine in an Advanced Heart Failure Cohort at a Tertiary Care Center Monique R. Robinson, Christine Koniaris, Michael Zacharias, JaMia Washington, Lauren Donnelly, Sadeer Al-Kindi, Guilherme Oliveira; University Hospitals, Cleveland, OH Background: The role of Palliative Medicine (PM) is increasingly acknowledged for patients with advanced heart failure (AHF). PM facilitates delineation of advanced directives (AD) -a quality metric for AHF, goals of care (GoC) and control of potentially debilitating symptoms. It is unclear whether PM has been well integrated into AHF clinical practice. Methods: Patients with ACC Stage C and D AHF hospitalized with acute HF decompensation over the course of a month were interviewed by the PM team for knowledge of PM, whether they had an AD, GoC or HF symptoms. Study participants were contacted by telephone one month following hospital discharge. Results: Of the 40 patients interviewed, median age was 67 years, 22 (55%) were male, 18 (45%) had ischemic cardiomyopathy, 27 (67.5%) were ACC stage C and 13 (32.5%) were ACC stage D. 93% had been hospitalized for HF at least once in the preceding year. Overall, 85% of patients had no prior knowledge of PM. 17 (42.5%) had AD and 4 (10%) had GoC prior to PM consultation. Presence of AD varied by patient characteristics (Fig. 1). It increased with age (tertile 1: 9%, tertile 2: 57%, tertile 3: 62%, P = .018), and was highest among patients with stage D vs. stage C (82% vs 30%, P = .005). More ADs were seen with males (52% vs 35%, P = .34), and with higher income groups (highest 100% vs lowest 13%, P = .16), and ischemic cardiomyopathy (56% vs 35%, P = .33). QoL did not vary significantly among those who had AD and those who did not. After PM consultation, a total of 47% patients had AD and 92% had GoC at discharge. One month post discharge a total of 25 (62%) patients had completed AD. Moreover, during hospitalization, patients identified dyspnea (35%), fatigue (45%), pain (43%) and depression (32%) as predominant symptoms. Telephone follow up was successful for 11 patients, who identified ongoing symptoms post discharge and were open to ongoing PM intervention. Conclusions: AD are a quality metric for AHF but there is relatively low uptake among patients with significant HF. Disparity exists in the number of patients with AD, with fewer AD among younger patients and those with ACC Stage C disease. Involving PM increases the number of AHF patients with AD and GoC. Moreover, despite medical management, one month post discharge our cohort continued to have symptoms that would benefit from continued PM intervention.
255 Obstructive Sleep Apnea is Associated with Increased Readmissions in CHF Patients Alex J. Sommerfeld1,2, Andrew D. Althouse1,2, Jennifer Prince2, Gavin W. Hickey1,2; 1 University of Pittsburgh, Pittsburgh, PA; 2VA Pittsburgh Health System, Pittsburgh, PA Background/Introduction: Congestive heart failure (CHF) accounts for over $17 billion in healthcare costs annually. Reduction of CHF readmissions has become a focus nationwide in efforts to reduce healthcare costs. We sought to characterize risk factors for readmission within 90 days in a population of patients admitted to the Veterans Affairs Pittsburgh Health System (VAPHS) with a primary discharge diagnosis of congestive heart failure (CHF). Methods: A total of 344 patient encounters with a primary discharge diagnosis of CHF were prospectively enrolled in a quality improvement database at Veterans Administration Pittsburgh Healthcare System (VAPHS) from September 2014 through September 2015. Our primary endpoints were readmission within 30 days and within 90 days. The risk of readmission within selected subgroups was compared using chi-squared tests. Multivariate logistic regression was used to assess multiple risk factors of readmission. Results: Patients were aged 72 ± 10 years, predominantly white (76.2%) and male (99.4%). Among the 344 patient encounters, 247 (71.8%) had diagnosed coronary artery disease, 159 (46.2%) had atrial fibrillation, 137 (39.8%) had heart failure with preserved ejection fraction (defined as EF ≥50%), and 109 (31.7%) had obstructive sleep apnea (OSA). Notably, patients with OSA had a higher rate of readmission within 30 days (OSA: 28.4% vs. No OSA: 20.0%, P = .08; see Figure) and within 90 days (OSA: 54.1% vs. No OSA: 37.0%, P < .01; see Figure). Patients with OSA had increased odds of readmission within 90 days (OR = 2.18, 95% CI 1.32–3.60, P < .01) even after adjustment for potential confounders including age, race, obesity, diabetes, and COPD. Conclusion: CHF patients with obstructive sleep apnea have an elevated rate of readmission compared to the general HF population, particularly within the first 90 days after discharge. Moreover, OSA is an independent risk factor for all-cause and CHF readmissions following hospitalization for CHF. These patients should be carefully examined to determine optimal management in order to decrease readmission rates.
256 Comparison of Characteristics and Outcomes in Patients with HFpEF and HFrEF: Result From KorAHF Registry Hyun-Jai Cho, Wonseok Choe, Heesun Lee, Sang Eun Lee, Hae-Young Lee, Byung-Hee Oh; Seoul National University Hospital, Seoul, South Korea Background: Patients with heart failure with preserved EF (HFpEF) have shown distinct characteristics, as compared with heart failure with reduced EF (HFrEF). Purpose: The aim of the study is to investigate the clinical characteristics and differences in short-term outcomes as well as predictors of in-hospital mortality between HFpEF and HFrEF in Asian population. Methods: We analyzed data from the Korean Acute Heart Failure (KorAHF) which is a nationwide prospective registry of patients hospitalized for acute heart failure syndrome in ten regionally-representative tertiary university hospitals in Korea. Clinical characteristics, all cause in-hospital mortality and predictors of mortality were compared between patients with HFpEF (LVEF ≥ 50%) and HFrEF (LVEF ≤ 40%). Patients with borderline LVEF (40–50%) were excluded from the analysis because of heterogeneity. Results: 5627 patients have been consecutively enrolled between March 2011 and March 2014. 24% of these patients had HFpEF and 57% had HFrEF. The median age of patients tend to be older in HFpEF than in
The 20th Annual Scientific Meeting HFrEF (72 vs 67 years). A larger proportion of patients were female in HFpEF (61% vs 39%). Valvular heart disease was the most common cause of heart failure in HFpEF (31%), whereas ischemic etiology was the most common cause in HFrEF (43%). The prevalence of hypertension (64% vs 56%) and atrial fibrillation (36% vs 23%) was higher in HFpEF. There was a significant difference in all cause in-hospital mortality (3.1% for HFpEF vs 5.2% for HFrEF, P < .01), but this mortality difference between HFpEF and HFrEF was not significant in a subgroup of patients with elevated BNP or NT-proBNP levels (BNP ≥ 1000 pg/mL and/or NT-proBNP ≥ 3500 pg/mL). Regarding the mode of death, non-cardiovascular (CV) deaths were more common in HFpEF patients (31%) than those in HFrEF (13.9%). The influence of old age (>70 years), pulmonary congestion, poor functional capacity (NYHA functional class III or IV) and Q wave in electrocardiogram on the risk of mortality was significantly greater in HFrEF than HFpEF. In contrast, the influence of lower BMI (<25 kg/m2) on the risk of mortality was significantly greater in HFpEF than HFrEF. Low systolic blood pressure (SBP < 100 mmHg) and renal dysfunction (serum Cr > 2.0 mg/dL) were the common predictors of adverse outcomes in both HFpEF and HFrEF patients. Conclusions: HFpEF showed better in-hospital outcome and different predictors of mortality, but the patient subgroup with elevated BNP level demonstrated similar poor outcomes, as compared with HFrEF. Non-CV deaths were more common in HFpEF than HFrEF, and low BMI was the major predictor of in-hospital mortality in HFpEF but not in HFrEF, suggesting that pre-existing medical conditions and a level of physical fitness could be more important factors for outcomes in HFpEF than HFrEF patients.
257 Current Smoking and a “Non-Paradoxical” Association with Mortality among Community-Dwelling Older Heart Failure Patients: Findings From the Cardiovascular Health Study Chakradhari Inampudi1, Amiya A. Ahmed2, Rahul Khosla3, Charity J. Morgan4, Prakash Deedwania5, Marc Blackman3, Javed Butler6, Gregg C. Fonarow7, Michel White8, Ross D. Fletcher3, Wilbert S. Aronow9, Ali Ahmed3; 1University of Iowa Hospitals and Clinics, Iowa City, IA; 2University of Maryland, Baltimore, MD; 3Veterans Affairs Medical Center, Washington, DC; 4University of Alabama at Birmingham, Birmingham, AL; 5 VA Medical Center, Fresno, CA; 6Stony Brook School of Medicine, Stony Brook, NY; 7 Ronald Reagan UCLA Medical Center, Los Angeles, CA; 8Montreal Heart Institute, 5000 Rue Bélanger, Montréal, QC H1T 1C7, Canada; 9Westchester Medical Center, Valhalla, NY Background: Smoking is risk factor for incident heart failure (HF) and death among older adults (PMID: 26038535). However, among hospitalized older HF patients, smoking has a paradoxical association with lower mortality (PMID: 18487210). We examined the association of smoking with mortality among community-dwelling older HF patients. Methods: Of the 223 community-dwelling adults ≥65 years with centrally-adjudicated prevalent HF in the NIH-funded Cardiovascular Health Study (CHS), 136 (61%) were never-smokers, 24 (11%) were current smokers and 63 (28%) were former smokers with >15 years of cessation. Age-sex-race-adjusted hazard ratios (aHR) and 95% CI for all-cause mortality during 13 (mean, 7) years of follow-up associated with current (vs. never) smoking were estimated using Cox regression models. Results: Patients had a mean (±SD) age of 76 (±6) years, 56% were women, and 21% African American. Overall, 170 (76%) patients died. Unadjusted all-cause mortality occurred in 83% and 72% of current smokers and never smokers, respectively (1.32; 95% CI, 0.81–2.13; Table). Current smokers were 4 years younger than never smokers. When adjusted for age and other demographics, this association became stronger but remained non-significant (aHR, 1.50; 95% CI, 0.91–2.49; Table). However, when current smokers were used as a dummy variable and compared with the combined groups of never smokers and former smokers with >15 years of cessation (cardiovascular risk of this latter group is similar to never smokers; PMID: 18487210), this association became of borderline significance (aHR, 1.61; 95% CI, 1.00–2.61). Conclusions: These findings suggest that unlike paradoxical survival benefit associated with smoking among hospitalized HF patients, current smoking may be associated with higher mortality among community-dwelling older HF patients. Greater emphasis for smoking cessation should be considered in this patients.
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258 Telemonitoring Reduced Costs and Inpatient Visitation Rates for Patients with Advanced Cardiovascular Disease: A Matched Cohort Study Telemonitoring Reduced Costs and in-Patient Visitation Rates for Patients with Advanced Cardiovascularddisease: A Matched Cohort Study Stephen Stanhope, Kelly May, Andrew Richardson, Marla Tribble, Kevin Vos, Michael Dickinson; Spectrum Health, Grand Rapids, MI Introduction: Reducing the cost of care of patients with cardiovascular disease is an important target for integrated health systems. Managing these patients is difficult and costly, with commensurately high rates of inpatient (IP) visitation. Hypothesis: Medical costs and IP visitation rates of patients receiving remote telemonitoring (TM) will decrease, relative to what they would have otherwise been. Methods: We performed a concurrent matched cohort study, comparing patients receiving TM to those who did not. Our treatment cohort includes all members of Priority Health, Grand Rapids, MI (PH) that received TM between January 2012 and September 2013. Members of the treatment cohort were matched 1:1 against non-TM members of PH, indexed on the month of TM enrollment. Matching criteria includes age and sex; chronic morbidity status (heart failure, COPD, HTN, diabetes); observed medical costs 12 and 6 months prior to initiation of TM; and IP utilization within 12 months prior to initiation of TM. Members were excluded from treatment and putative control cohorts if they did not have continuous enrollment for 12 months prior and 24 months post initiation of TM. Endpoints include 24 month cumulative medical cost and IP visitations. Results: We provide population-level metrics (Table) with 80% confidence intervals for endpoint differences and average cumulative cost and inpatient visitation curves (Figure) for our treatment and matched control cohorts. Conclusions: Remote telemonitoring of patients with advanced cardiovascular disease can reduce inpatient
254 Evaluating the Role of Palliative Medicine in an Advanced Heart Failure Cohort at a Tertiary Care Center Monique R. Robinson, Christine Koniaris, Michael Zacharias, JaMia Washington, Lauren Donnelly, Sadeer Al-Kindi, Guilherme Oliveira; University Hospitals, Cleveland, OH Background: The role of Palliative Medicine (PM) is increasingly acknowledged for patients with advanced heart failure (AHF). PM facilitates delineation of advanced directives (AD) -a quality metric for AHF, goals of care (GoC) and control of potentially debilitating symptoms. It is unclear whether PM has been well integrated into AHF clinical practice. Methods: Patients with ACC Stage C and D AHF hospitalized with acute HF decompensation over the course of a month were interviewed by the PM team for knowledge of PM, whether they had an AD, GoC or HF symptoms. Study participants were contacted by telephone one month following hospital discharge. Results: Of the 40 patients interviewed, median age was 67 years, 22 (55%) were male, 18 (45%) had ischemic cardiomyopathy, 27 (67.5%) were ACC stage C and 13 (32.5%) were ACC stage D. 93% had been hospitalized for HF at least once in the preceding year. Overall, 85% of patients had no prior knowledge of PM. 17 (42.5%) had AD and 4 (10%) had GoC prior to PM consultation. Presence of AD varied by patient characteristics (Fig. 1). It increased with age (tertile 1: 9%, tertile 2: 57%, tertile 3: 62%, P = .018), and was highest among patients with stage D vs. stage C (82% vs 30%, P = .005). More ADs were seen with males (52% vs 35%, P = .34), and with higher income groups (highest 100% vs lowest 13%, P = .16), and ischemic cardiomyopathy (56% vs 35%, P = .33). QoL did not vary significantly among those who had AD and those who did not. After PM consultation, a total of 47% patients had AD and 92% had GoC at discharge. One month post discharge a total of 25 (62%) patients had completed AD. Moreover, during hospitalization, patients identified dyspnea (35%), fatigue (45%), pain (43%) and depression (32%) as predominant symptoms. Telephone follow up was successful for 11 patients, who identified ongoing symptoms post discharge and were open to ongoing PM intervention. Conclusions: AD are a quality metric for AHF but there is relatively low uptake among patients with significant HF. Disparity exists in the number of patients with AD, with fewer AD among younger patients and those with ACC Stage C disease. Involving PM increases the number of AHF patients with AD and GoC. Moreover, despite medical management, one month post discharge our cohort continued to have symptoms that would benefit from continued PM intervention.
255 Obstructive Sleep Apnea is Associated with Increased Readmissions in CHF Patients Alex J. Sommerfeld1,2, Andrew D. Althouse1,2, Jennifer Prince2, Gavin W. Hickey1,2; 1 University of Pittsburgh, Pittsburgh, PA; 2VA Pittsburgh Health System, Pittsburgh, PA Background/Introduction: Congestive heart failure (CHF) accounts for over $17 billion in healthcare costs annually. Reduction of CHF readmissions has become a focus nationwide in efforts to reduce healthcare costs. We sought to characterize risk factors for readmission within 90 days in a population of patients admitted to the Veterans Affairs Pittsburgh Health System (VAPHS) with a primary discharge diagnosis of congestive heart failure (CHF). Methods: A total of 344 patient encounters with a primary discharge diagnosis of CHF were prospectively enrolled in a quality improvement database at Veterans Administration Pittsburgh Healthcare System (VAPHS) from September 2014 through September 2015. Our primary endpoints were readmission within 30 days and within 90 days. The risk of readmission within selected subgroups was compared using chi-squared tests. Multivariate logistic regression was used to assess multiple risk factors of readmission. Results: Patients were aged 72 ± 10 years, predominantly white (76.2%) and male (99.4%). Among the 344 patient encounters, 247 (71.8%) had diagnosed coronary artery disease, 159 (46.2%) had atrial fibrillation, 137 (39.8%) had heart failure with preserved ejection fraction (defined as EF ≥50%), and 109 (31.7%) had obstructive sleep apnea (OSA). Notably, patients with OSA had a higher rate of readmission within 30 days (OSA: 28.4% vs. No OSA: 20.0%, P = .08; see Figure) and within 90 days (OSA: 54.1% vs. No OSA: 37.0%, P < .01; see Figure). Patients with OSA had increased odds of readmission within 90 days (OR = 2.18, 95% CI 1.32–3.60, P < .01) even after adjustment for potential confounders including age, race, obesity, diabetes, and COPD. Conclusion: CHF patients with obstructive sleep apnea have an elevated rate of readmission compared to the general HF population, particularly within the first 90 days after discharge. Moreover, OSA is an independent risk factor for all-cause and CHF readmissions following hospitalization for CHF. These patients should be carefully examined to determine optimal management in order to decrease readmission rates.
256 Comparison of Characteristics and Outcomes in Patients with HFpEF and HFrEF: Result From KorAHF Registry Hyun-Jai Cho, Wonseok Choe, Heesun Lee, Sang Eun Lee, Hae-Young Lee, Byung-Hee Oh; Seoul National University Hospital, Seoul, South Korea Background: Patients with heart failure with preserved EF (HFpEF) have shown distinct characteristics, as compared with heart failure with reduced EF (HFrEF). Purpose: The aim of the study is to investigate the clinical characteristics and differences in short-term outcomes as well as predictors of in-hospital mortality between HFpEF and HFrEF in Asian population. Methods: We analyzed data from the Korean Acute Heart Failure (KorAHF) which is a nationwide prospective registry of patients hospitalized for acute heart failure syndrome in ten regionally-representative tertiary university hospitals in Korea. Clinical characteristics, all cause in-hospital mortality and predictors of mortality were compared between patients with HFpEF (LVEF ≥ 50%) and HFrEF (LVEF ≤ 40%). Patients with borderline LVEF (40–50%) were excluded from the analysis because of heterogeneity. Results: 5627 patients have been consecutively enrolled between March 2011 and March 2014. 24% of these patients had HFpEF and 57% had HFrEF. The median age of patients tend to be older in HFpEF than in
The 20th Annual Scientific Meeting HFrEF (72 vs 67 years). A larger proportion of patients were female in HFpEF (61% vs 39%). Valvular heart disease was the most common cause of heart failure in HFpEF (31%), whereas ischemic etiology was the most common cause in HFrEF (43%). The prevalence of hypertension (64% vs 56%) and atrial fibrillation (36% vs 23%) was higher in HFpEF. There was a significant difference in all cause in-hospital mortality (3.1% for HFpEF vs 5.2% for HFrEF, P < .01), but this mortality difference between HFpEF and HFrEF was not significant in a subgroup of patients with elevated BNP or NT-proBNP levels (BNP ≥ 1000 pg/mL and/or NT-proBNP ≥ 3500 pg/mL). Regarding the mode of death, non-cardiovascular (CV) deaths were more common in HFpEF patients (31%) than those in HFrEF (13.9%). The influence of old age (>70 years), pulmonary congestion, poor functional capacity (NYHA functional class III or IV) and Q wave in electrocardiogram on the risk of mortality was significantly greater in HFrEF than HFpEF. In contrast, the influence of lower BMI (<25 kg/m2) on the risk of mortality was significantly greater in HFpEF than HFrEF. Low systolic blood pressure (SBP < 100 mmHg) and renal dysfunction (serum Cr > 2.0 mg/dL) were the common predictors of adverse outcomes in both HFpEF and HFrEF patients. Conclusions: HFpEF showed better in-hospital outcome and different predictors of mortality, but the patient subgroup with elevated BNP level demonstrated similar poor outcomes, as compared with HFrEF. Non-CV deaths were more common in HFpEF than HFrEF, and low BMI was the major predictor of in-hospital mortality in HFpEF but not in HFrEF, suggesting that pre-existing medical conditions and a level of physical fitness could be more important factors for outcomes in HFpEF than HFrEF patients.
257 Current Smoking and a “Non-Paradoxical” Association with Mortality among Community-Dwelling Older Heart Failure Patients: Findings From the Cardiovascular Health Study Chakradhari Inampudi1, Amiya A. Ahmed2, Rahul Khosla3, Charity J. Morgan4, Prakash Deedwania5, Marc Blackman3, Javed Butler6, Gregg C. Fonarow7, Michel White8, Ross D. Fletcher3, Wilbert S. Aronow9, Ali Ahmed3; 1University of Iowa Hospitals and Clinics, Iowa City, IA; 2University of Maryland, Baltimore, MD; 3Veterans Affairs Medical Center, Washington, DC; 4University of Alabama at Birmingham, Birmingham, AL; 5 VA Medical Center, Fresno, CA; 6Stony Brook School of Medicine, Stony Brook, NY; 7 Ronald Reagan UCLA Medical Center, Los Angeles, CA; 8Montreal Heart Institute, 5000 Rue Bélanger, Montréal, QC H1T 1C7, Canada; 9Westchester Medical Center, Valhalla, NY Background: Smoking is risk factor for incident heart failure (HF) and death among older adults (PMID: 26038535). However, among hospitalized older HF patients, smoking has a paradoxical association with lower mortality (PMID: 18487210). We examined the association of smoking with mortality among community-dwelling older HF patients. Methods: Of the 223 community-dwelling adults ≥65 years with centrally-adjudicated prevalent HF in the NIH-funded Cardiovascular Health Study (CHS), 136 (61%) were never-smokers, 24 (11%) were current smokers and 63 (28%) were former smokers with >15 years of cessation. Age-sex-race-adjusted hazard ratios (aHR) and 95% CI for all-cause mortality during 13 (mean, 7) years of follow-up associated with current (vs. never) smoking were estimated using Cox regression models. Results: Patients had a mean (±SD) age of 76 (±6) years, 56% were women, and 21% African American. Overall, 170 (76%) patients died. Unadjusted all-cause mortality occurred in 83% and 72% of current smokers and never smokers, respectively (1.32; 95% CI, 0.81–2.13; Table). Current smokers were 4 years younger than never smokers. When adjusted for age and other demographics, this association became stronger but remained non-significant (aHR, 1.50; 95% CI, 0.91–2.49; Table). However, when current smokers were used as a dummy variable and compared with the combined groups of never smokers and former smokers with >15 years of cessation (cardiovascular risk of this latter group is similar to never smokers; PMID: 18487210), this association became of borderline significance (aHR, 1.61; 95% CI, 1.00–2.61). Conclusions: These findings suggest that unlike paradoxical survival benefit associated with smoking among hospitalized HF patients, current smoking may be associated with higher mortality among community-dwelling older HF patients. Greater emphasis for smoking cessation should be considered in this patients.
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258 Telemonitoring Reduced Costs and Inpatient Visitation Rates for Patients with Advanced Cardiovascular Disease: A Matched Cohort Study Telemonitoring Reduced Costs and in-Patient Visitation Rates for Patients with Advanced Cardiovascularddisease: A Matched Cohort Study Stephen Stanhope, Kelly May, Andrew Richardson, Marla Tribble, Kevin Vos, Michael Dickinson; Spectrum Health, Grand Rapids, MI Introduction: Reducing the cost of care of patients with cardiovascular disease is an important target for integrated health systems. Managing these patients is difficult and costly, with commensurately high rates of inpatient (IP) visitation. Hypothesis: Medical costs and IP visitation rates of patients receiving remote telemonitoring (TM) will decrease, relative to what they would have otherwise been. Methods: We performed a concurrent matched cohort study, comparing patients receiving TM to those who did not. Our treatment cohort includes all members of Priority Health, Grand Rapids, MI (PH) that received TM between January 2012 and September 2013. Members of the treatment cohort were matched 1:1 against non-TM members of PH, indexed on the month of TM enrollment. Matching criteria includes age and sex; chronic morbidity status (heart failure, COPD, HTN, diabetes); observed medical costs 12 and 6 months prior to initiation of TM; and IP utilization within 12 months prior to initiation of TM. Members were excluded from treatment and putative control cohorts if they did not have continuous enrollment for 12 months prior and 24 months post initiation of TM. Endpoints include 24 month cumulative medical cost and IP visitations. Results: We provide population-level metrics (Table) with 80% confidence intervals for endpoint differences and average cumulative cost and inpatient visitation curves (Figure) for our treatment and matched control cohorts. Conclusions: Remote telemonitoring of patients with advanced cardiovascular disease can reduce inpatient