Randomized Trial of Tele-Heart: An Integrated Telehealth Intervention for Depressed Homebound Older Adults with Heart Disease

Background and Purpose: Telehealth care is emerging as a viable cost-effective intervention model to treat complex chronic conditions comorbid with depression. We report on a randomized controlled trial evaluating the impact of a multifaceted Telehealth intervention known as Tele-H.E.A.R.T. (Heart Education Activation Rehabilitation and Treatment) on health and depression outcomes for homebound isolated older adults with heart failure or COPD. Heart disease is a common primary diagnosis and the leading cause of death among older patients. It is also one of the main causes of hospitalization adults and is associated with greater impairment than arthritis, diabetes, or lung disease. Depression is prevalent and a serious comorbidity in heart disease with negative consequences including higher levels of chronic physical illness, decreased psychological well-being, and increased healthcare costs. We hypothesized that older adults receiving Telehealth intervention would receive significantly better quality of care resulting in improved scores in health-related quality of life, depression, and satisfaction with care at 3-months and service utilization outcomes at 12-months follow-up compared to controls.

Methods. One hundred and fifteen participants were recruited from a university-affiliated home healthcare agency for the trial. The Tele-H.E.A.R.T. intervention sessions were provided over a 3-month period and included integrated cardiac and depression care, a telehealth in-home monitoring unit for vital signs, problem solving strategies on managing chronic conditions using manualized Problem Solving Therapy (PST), behavioral activation, homework, and weekly check-in telephone calls. The comparison group received 3-months of usual in-home skilled nursing care that included cardiac monitoring, education, and a depression brochure. Outcome measures included the Patient Health Questionnaire, Center for Epidemiologic Studies Depression Scale, SF-36 Health-related Quality of Life, Satisfaction with Care and service utilization. An “intent to treat” analysis was conducted with all randomized patients kept in the analysis. Baseline demographic variables were compared by using independent sample t-tests and chi-square tests. Random effects regression modeling (RERM) was the main analytic method used for assessing outcome measures.

Results: At follow-up, the Telehealth intervention group reported greater increases in general health and social functioning, and improved depression scores as compared to usual care. The telehealth group had significantly less visits to the emergency department than the usual care group. There was an observed positive trend towards less hospital days for telehealth participants but it did not reach significance at 12 months.

Conclusions and Implications: The Tel-H.E.A.R.T. program is an example of a “real world” evidence-based model to integrate telehealth technology into healthcare settings serving homebound patients diagnosed with heart or chronic respiratory failure. The goal of this program is to screen for risk factors, integrate care processes including referral, documentation, team communication, evidence-based treatment, evaluate health and depression care outcomes, examine episodes of care, emergency room use and hospital readmissions, and achieve cost effectiveness over time. Telehealth may be an efficient and effective method of synergistically delivering care in the home health sector. The use of telehealth technology may benefit homebound older adults who have difficulty accessing care due to isolation, disability, or transportation.