Dolores Davis has been hospitalized at least four times for congestive heart failure since December 2010.
As excessive as that may sound, it's not unusual.
Heart failure is the leading cause of hospitalization in people over age 65.
But what if there was something you could do from the comfort of your own home to reduce that risk?
Doctors at UCLA recently published a report on how home monitoring may help manage and reduce costs for heart failure - a chronic condition where the heart is unable to pump enough blood.
"Heart failure is a disease state that affects close to 6 million men and women in the United States," said Dr. Gregg Fonarow, a professor of cardiovascular medicine at UCLA.
"A number of different heart conditions can come together into this clinical syndrome that's known as heart failure," he said. "These individuals have an impairment in their heart function in a way that contributes to symptoms like shortness of breath and exercise intolerance. These patients have a higher risk of arrhythmia, hospitalizations and by natural history a much shortened survival."
Heart failure can occur at any age, including among newborns, but the risk increases with age. Some causes of the disease include high blood pressure, diabetes, prior heart attacks, coronary artery disease and heart defects at birth.
In the past, heart failure was thought of as a terminal diagnosis, with patients living one to two years. But Fonarow says there have been a number of therapeutic advances that greatly improve prognosis.
In heart failure patients, the body often retains fluid and sodium. Fluid can cause the body to become congested, building up in the ankles, legs, arms, lungs or other organs. This is known as congestive heart failure.
"Congestion can lead to worsening symptoms that can frequently require hospitalizations. And these patients, particularly, require a number of different medications that need to be adjusted. They need to monitor their sodium intake, they need to monitor their weight on a scale each day and there are all sorts of other elements to their care that are involved," Fonarow said.
"If the congestion is not detected early, by the time the patient is having worsening symptoms they can be severe enough that they require hospitalizations, which can be expensive and average four to six days and up to $10,000 or more per hospitalization."
Home-monitoring options
The concept of home monitoring is to enhance the care and monitoring of patients in their home environment to detect early and subtle changes in the patient's health. This would allow changes in treatment to occur sooner, increasing the chances of its effectiveness and, therefore, reducing the likelihood of hospitalization, says Fonarow.
There are a number of home-monitoring methods including patients using external or implanted sensors that allow a clinician to access data through a cellphone or the Internet, allowing them to monitor the patient remotely.
Other forms of home monitoring include home visits by doctors or nurses; self-care such as daily weighings and medicine management; and telephone contact between the health care provider and patient in between doctor visits.
Fonarow says the success of home monitoring has varied in different settings and there are various elements that go into its success, such as effective communication and patient follow-through.
But one form of home monitoring seems to be more effective than others.
A small sensor inserted in the patient's pulmonary artery that allows a physician to track the patient's artery pressure wirelessly has been shown to reduce hospitalization in heart failure patients by 40 percent, says Fonarow.
"So we do find some evidence that home monitoring for certain heart failure patients does appear to be very effective," Fonarow said.
Davis, 65, of Venice, ended her most recent hospitalization at UCLA last week, and she hopes it's her last. Prior to leaving the hospital she was prepped to begin home monitoring.
She was given a packet of information providing details of her disease and how her diet can help or harm her prognosis.
Davis is on a multitude of medications including water pills, medication for high blood pressure, potassium pills and cholesterol pills.
A machine that hooks up to her home telephone transmits results after she measures her blood pressure and weighs herself daily, allowing her doctors to monitor her progress from a distance.
She also has a CPAP (continuous positive airway pressure) machine that pumps air into her lungs to help her breathe better at night.
"I did not recognize what the warning signs were before it got to a serious stage, I just thought it was a cold and I was trying to cure myself. Next thing I know I can hardly breathe and hardly walk," Davis said. "This is training me and showing me how to detect the warning signs before it gets to that stage and what to do to prevent it. I feel like I'm in more control of what's happening with me."
Davis thinks more people should consult their doctors and ask if home monitoring is a possibility with their treatment to ensure their health.
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