October 16, 2003
Daily Monitoring and Reporting of Weight and
Symptoms by Heart Failure Patients Using an Electronic
Scale Lowers Mortality Rates, Study Finds
(Philadelphia, PA) -- Patients with advanced heart failure
who reported daily to health-care professionals any
changes in weight or symptoms associated with the illness
had significantly lower mortality rates than their unmonitored
peers, according to a national study led by investigators
in the Heart Failure and Cardiac Transplant Program
at the University of Pennsylvania Medical Center.
The findings are published this week in the American
"The findings were a surprise," said Lee
R. Goldberg, MD, MPH, Assistant Professor of
Medicine in Penn's School of Medicine and principal
investigator for the study. "We set out to determine
whether the rate of hospitalization for patients who
reported their weight and symptoms to health-care personnel
on a daily basis might be lower than the rate for unmonitored
patients. Instead, we found the hospitalization rates
were essentially the same for both groups -- but there
was a striking disparity in their mortality rates over
the period of the study."
Over six months, the nurse-monitored group sustained
11 deaths, while the unmonitored group sustained 26
deaths -- a 56 percent difference in mortality rates.
Goldberg said the impact on mortality was demonstrated
despite "aggressive medical management for both
patient groups," and it held true for patients
of heart transplant centers as well as community medical
"Guidelines for the Management of Heart Failure,"
recently issued jointly by the American College of Cardiology
and the American Heart Association, make daily weight
monitoring the cornerstone for the medical management
of patients with advanced heart failure. But until Goldberg's
study, there had been no prospective,
randomized clinical trial designed to evaluate the effectiveness
of such monitoring.
The study followed nearly 300 patients at eight cardiac
transplant centers and eight community-based cardiology
medical practices. All patients received standard medical
care; 138 patients were also assigned to use the AlereNet
daily monitoring system (manufactured by Alere Medical,
Incorporated, of Reno, NV).
Patients in the AlereNet group relied on a technology
system that included an electronic scale and personalized
response mechanism tied into their home telephone line.
They were instructed to weigh themselves and to answer
a set of five questions tailored to their individual
symptoms twice each day. The information was sent to
a control center and reviewed by nurses once daily over
the course of the study.
Patients in the standard care group were advised to
weigh themselves daily and keep a log of weight gains
and losses, and they were instructed to contact their
personal physician about weight increases above a prescribed
amount or about any worsening symptoms. They were also
asked to bring their weight log with them to the study's
regularly scheduled cardiologist visits.
"We are not certain what caused the disparity in
mortality rates," Goldberg said. "But the
sole difference in the two groups appears to be the
daily monitoring by trained nurses in the AlereNet group,
which means those patients may have been more likely
to benefit from rapid medical intervention."
The study was funded by Alere Medical, Incorporated.
Others who collaborated with Goldberg in the study are:
John D. Piette, PhD, of the Veterans Administration
Center for Practice Management and Outcomes Research,
and the University of Michigan, Ann Arbor, MI; Marine
Norine Walsh, MD, of Indiana University and St. Vincent's
Hospital of Indianapolis, IN; Theodore A. Frank, MD,
of the Sanger Clinic, Charlotte, NC; Brian E. Jaski,
MD, of the San Diego Cardiac Center, Sharp Memorial
Hospital, San Diego, CA; Andrew L. Smith, MD, of Emory
University Division of Cardiology; Atlanta, GA; Raymond
Rodriquez, MD, of Chestnut Hill Cardiology, Flourtown,
PA; Donna M. Mancini, MD, of Columbia University, New
York, NY; Laurie A. Hopton, RN, BSN, of Penn; John Orav,
PhD, of Brigham and Women's Hospital Department of Medicine;
and Evan Loh, MD, of Wyeth Ayerst Research, Philadelphia,
PA, and medical investigators at the study sites.
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Dr. Goldberg has no financial interest in Alere Medical
Ms. Hopton has no financial interest in Alere Medical
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