Monitor Your Health
Program Checks Heart Patients At Home
Akron Beacon Journal

Every morning, Almon Leyda weighs in at Akron General Medical Center -- without leaving his home in Doylestown.

The 82-year-old congestive heart failure patient simply slips off his slippers and steps on a scale that's connected via the telephone line to a computer system at the hospital. A computerized voice on the telescale asks him a series of questions that raise red flags for heart problems -- things such as, "Are you feeling more short of breath?" and "Are your ankles or feet more swollen?"

To respond, he simply pushes the "yes" or "no" keys on the scale.

A weight gain of 3 pounds overnight or a worrisome answer to one of the questions prompts an immediate call from clinical nurse specialist Ann Krosnick. Just as an overprotective mother would do, Krosnick also calls if Leyda forgets to get on the scale.

"I think it's good," he says. "It keeps them in touch."

The scale keeps Leyda out of the hospital, too. Since Akron General gave him the scale and enrolled him in its free new monitoring program about four months ago, he hasn't been hospitalized.

And that's the ultimate goal of the program for congestive heart failure patients, says Helen Conroy, co-director of Akron General's Care Management Department.

"It really is putting some ownership on the patient to understand their disease," she says. The program -- called Vigilance Monitoring -- started on a trial basis with 10 patients last year as part of Akron General Health System's ongoing effort to coordinate care of the sickest patients.

The results: Patients who previously were admitted to the hospital two or more times in a six-month period didn't have a single readmission six months after starting the program.

"It's a powerful educational tool, because the patients are paying attention to their health,'' says Dr. Richard Streck, the medical center's senior vice president of medical affairs.

More than 4 million Americans suffer from congestive heart failure, which is the most common reason for admission to hospitals among senior citizens. With this condition, the heart can't pump enough blood to meet the oxygen and nutrient needs of the body's other organs.

As a self-correcting measure to the heart's decreased pumping ability, the body retains water.

Initially, the additional water increases the volume of blood in circulation and improves the heart's performance. But as the heart deteriorates, the excess fluid escapes from circulation and accumulates in various body sites, causing swelling and sudden weight gain. In the worst circumstances, the fluid backs up into the lungs.

Medical experts agree it's important for people with congestive heart failure to closely monitor their weight so their medications can be adjusted when they begin retaining water.

But these are often patients who got into trouble in the first place for failing to follow a doctor's orders to limit salt intake or to take their medicine.

Numerous studies have shown that patients benefit from programs that educate them about their disease and help them monitor it.

A study published in the New England Journal of Medicine in 1995 found that a nurse-directed intervention program can improve quality of life and reduce hospital use and medical costs for elderly patients with congestive heart failure.

"It's real helpful in the group (that) seems to not understand the situation or have trouble complying with therapy,'' says Dr. George Litman, an Akron cardiologist and chief of cardiology at Akron General, who has about 10 patients in the program. "Having this device and having the ability to talk to people on a daily basis seems to help."

Patients who have been admitted at least twice within a six-month period for heart failure complications are eligible for Akron General's monitoring program, says Krosnick, a clinical nurse specialist. Patients and their physicians must agree to participate.

About 40 people currently are enrolled in the program, which can last from a month to an indefinite period of time, depending on how much help patients need managing their condition, Krosnick says.

Although other hospitals in Northeast Ohio have programs to help their congestive heart failure patients manage their disease, Akron General is apparently the only one using a telescale to stay in daily contact.

The hospital has invested about $100,000 in the program, spokesman Joe Jerek says. The economic incentives are obvious. In most cases, the hospital loses money on these patients, Jerek says. The average cost per in-patient stay for congestive heart failure is $5,200, but Medicare only reimburses an average of $4,500.

Each year, Akron General has about 925 admissions for heart failure.

Although patients aren't billed for the program, Akron General is trying to persuade managed-care companies to reimburse them for at least a portion of the cost, Streck says.

After all, keeping patients out of the hospital saves insurers money, too.

Nationwide, several managed-care companies also are starting similar programs of their own, says Daniel Cosentino, president of Cardiocom, a Minneapolis company that provides the telescales and computer system for Akron General.

Beyond the money issues, the program is a patient-pleaser, he says.

"The patients love it, because now you're putting them in touch with a qualified medical professional when they need it," Cosentino says. "They have a very positive response in the marketplace."

Sherri Massey is among the satisfied patients.

The Akron woman has been in and out of the hospital since she developed congestive heart failure caused by cardiomyopathy after her last pregnancy in 1986.

After her last discharge about a month ago, Akron General sent a telescale to her home via UPS and enrolled her in the monitoring program.

Before the hospital provided the scale, she rarely bothered to check her weight. "It helps me out,'' she says. "So far, I've been doing pretty good."