Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington – D.C., 2014

The Electronic Collection and Presentation of

Nocturnal Heart Failure

Cubby L. Gardner

1

, Harry B. Burke

2

H

eart failure is a major public health problem in the United States (U.S.), with high personal and institutional

costs.

1,2

Reducing heart failure readmissions is a national priority.

3,4

Most heart failure data is often have

difficulty appropriately recognizing and responding to their worsening heart failure.

5–8

Heart failure patients

experience a high burden of night time symptoms that reduce quality of life and increase their risk of hospi-

talization.

8–13

Unfortunately, there is little systematic literature addressing nocturnal heart failure, despite new findings that

a number of physiological functions exhibit circadian rhythmicity, including cardiovascular function

13

stress,

14

and extracel-

lular fluid shifts.

redolfi_s_no cturnal_2010

The current approach to the description of heart failure relies on data collected

in hospitals and clinics. The problem is that most heart failure patients experience acute exacerbations outside of hospitals

and clinics, often at night, at home, when signs and symptoms of disease are not systematically collected. This investigation

explores the application of FDA approved technology

15

to acquire information related to the detection of progressive heart

failure decomp ensation at home.

16

Methods: This study assesses the feasibility of using physiologic data acquisition devices and a tablet-based application to

collect disease-related data in home-dwelling heart failure patients. After data have been collected, clinicians assess the us-

ability of an electronic display of nocturnal heart failure information derived from the database of physiologic and subjective

data. This study asks the following research questions: 1) What is the feasibility of collecting ecologically valid physiological

data (heart rate, respiratory rate, blood oxygen saturation, blood pressure, and weight) and subjective data(self-assessment

features such as relative shortness of breath, swelling, pain, moo d, appetite) by home-dwelling heart failure patients? 2) Can

an electronic display of physiological and psychological data be constructed that meaningfully conveys nocturnal heart failure

information? 3) What is the patients’ and clinicians’ assessment of the usability of a system for electronically collecting and

presenting nocturnal heart failure information? The setting for this study is Walter Reed National Military Medical Center.

Results: The results of the investigation are pending completion of data collection. We will determine the feasibility of

collecting and displaying physiologic and subjective data collected from home-dwelling heart failure patients. Descriptive and

summary statistics will be used to characterize the sample and describe feasibility. Patients will evaluate the us ability of the

data collection devices using the System Usability Scale, which is a 10-item instrument assessing dimensions of usability.

17

Each dimension of usability is assessed on a 5-point Likert scale. Responses are calculated to pro duce a score from 0 to

100, with 68 representing an average score. Intra-class correlations will be calculated across devices and patients. With the

collected data, we will create an electronic display of nocturnal heart failure information. Clinicians will assess usability of

the information display with the System Usability Scale.

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The investigators hypothesize that the mean score will be greater

than 68. This hypothesis will be evaluated with the two-tailed Student’s t-test. The study is powered (n=37) to detect a

10-point difference at 0.80 power, alpha = 0.05.

Discussion: There is little or no research on the physiological and subjective states of home-dwelling heart failure patients

over night. In this study we investigate the feasibility and usability of a system to collect physiologic and subjective informa-

tion from heart failure patients, in their homes, at night. Then we assess clinicians’ perceptions of usability of a system to

display information constructed from the collected data. We anticipate that this electronic display will demonstrate above

average usability.

Conclusion: This study is a first step toward developing an understanding of nocturnal heart failure in home-dwelling

patients and methods to capture reliable physiologic and subjective data. We believe that this system will, in the future

provide valuable information for clinicians to improve their management of heart failure patients.

References

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http://www.cdc.gov/heartdisease/facts.htm.

2. Defense, D of. Department of Defense. 2012 MHS Stakeholders Report. Military Health System. 2013. url: http :

//www.health.mil/About_MHS/StakeholdersReport.aspx.

3. ASPA. About the Law. 2013. url: http://www.hhs.gov/healthcare/rights/.

1

Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences

2

School of Medicine, Uniformed Services University of Health Sciences

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H3IT: Home Healthcare, Hospice, and Information Technology Conference Washington – D.C., 2014

4. Medicare, C for and Services, M. Readmissions Reduction Program. Acute Inpatient PPS - Readmissions Reduction

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issues, 2003.

13. Mheid, IA, Corrigan, F, Shirazi, F, et al. Circadian Variation in Vascular Function and Regenerative Capacity in Healthy

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