Automated Hovering for Congestive Heart Failure Patients

Using a 2-arm, randomized, controlled trial (RCT) among congestive heart failure (CHF)
patients at the University of Pennsylvania Health System (UPHS), to test the effectiveness of
applying automated hovering to improve outcomes among CHF patients at high risk of
readmission. This will leverage the electronic medical record (EMR), the Penn Data Store (an
electronic repository that can be used to identify study cohorts), and the NIH-funded Way to
Health platform, which provides linkages between home-based remote monitoring devices and a
server that can provide automated feedback to patients. The primary outcome will be hospital
readmission rate during the 12 months of study enrollment. Secondary outcomes will include
cost, medication adherence and death. The investigators will enroll CHF patients discharged
from UPHS and randomize them to either: usual care with no additional intervention; or 1) the
provision of wireless pill bottles and scales with daily lottery incentives to encourage
daily adherence 2) asked to provide the name and contact information of a family member or
friend to serve as their support partner 3) have their weights monitored for clinically
significant threshold, with verified weight gains alerts sent to the managing physician
through the EMR. Managing providers will also be sent a weekly report of all weight
measurements from the electronic scale.

Inclusion Criteria:

- Patients with a recent University of Pennsylvania Health System hospital (UPHS)
discharge of congestive heart failure (CHF) aged 18-80 who will receive follow-up in a
UPHS outpatient clinic.

Exclusion Criteria:

- Patients will be excluded if they will not or cannot give consent or have a markedly
shortened life expectancy (listed for heart transplant,have a ventricular assist
device, are inotrope dependent, metastatic cancer, or dementia)

- end-stage renal disease (since they may not produce urine and be responsive to
diuretics).

- on dialysis

- Heart failure managed with a CardioMEMS monitor

- Receiving another remote monitoring/telemedicine intervention

- Receiving follow up care outside of UPHS