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Home monitoring gives health care by modem

The first thing Rinaldo J. Bucci does each morning is have his heart monitored for the sort of trouble that landed him in the hospital in January, short of breath and bloated with fluids.

But he doesn't have to leave home. In a low-tech application of telemedicine - technology that enables physicians to consult on cases around the globe by computer hookup - Bucci weighs in with a nurse practitioner at the University of Maryland Medical Center from his bedside in Bel Air.

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It takes less than 15 minutes for the 70-year-old retired engineer to step on a scale, don a blood-pressure cuff and wrap two heart-rhythm sensors around his wrists. The devices automatically turn on a modem that relays vital information over a telephone line to nurse Kay Branum, who looks for trouble signs that could warrant a medication change or other action.

"At least two times I am 100 percent positive that Kay kept me out of the hospital," Bucci said. The program is supervised by Dr. Stephen S. Gottlieb, a heart-failure specialist testing the idea that home monitoring can keep patients out of the hospital and save Medicare huge expenditures in the process.

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Since the program began earlier this year, about 40 patients recruited through their private doctors have started home monitoring. They are being compared to an equal number under the care of doctors but are not being checked as closely.

Gottlieb hopes eventually to have 600 patients enrolled in the five-year, federally funded study.

The United States spends an estimated $10 billion to $40 billion on heart failure annually, much of it on lengthy hospitalizations. The disease is the leading expense for Medicare, which covers about 700,000 hospitalizations for it each year.

Heart failure is a disorder in which the heart fails to pump vigorously, leading to reduced blood flow and the accumulation of fluid in the lungs, feet and other areas. About 4.7 million Americans are afflicted.

One sign of a problem is sudden weight gain, which can mean the body is retaining fluid. Increasing the dosage of a diuretic, which flushes fluids from the body, can control the condition - but only if a medical professional diagnoses it early.

Every day, Branum's computer tells her which patients have abnormal weight gain, suspect heart rhythms or blood pressure problems. She calls those who are having trouble, sometimes suggesting they adjust their medication.

"Some patients may get abnormal [readings] maybe once in three months," she said. "But some may need to be adjusted every day for two or three weeks at a time, then may go a month without needing adjustment."

Gottlieb said it will take more patients and up to five years of study to determine if the monitoring works. "Anecdotally, we are convinced that there are patients we've kept out of the hospital by being able to monitor them this closely," he said.

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From an economic standpoint, one measure of success will be whether the $200-per-patient monthly rental fee for equipment is outweighed by savings in hospital costs.

Bucci, who enrolled in the program shortly after he was discharged from the hospital in January, said the routine of checking his heart every day has made him more aware of his health. Though nobody told him to, he keeps a daily log of the readings and thinks more about his diet.

"If you go out and eat a lot of hard crabs with lots of salt, you'll retain some fluids," Bucci said. "My daughter gives me hell for even having them, but I just watch how much."


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