Patient-Centered Disease Management for Heart Failure Study

Across the United States, especially within the Veterans Affairs healthcare system, heart failure (HF) is reported to cause hospitalization, disability, and death.

HF affects all aspects of a patient’s health status. Often, patients’ inadequate understanding of their condition and the intervention prescribed to treat it leads to poor outcomes.

Researchers recently developed a multi-disciplinary intervention to assist patients with HF. JAMA Internal Medicine published the results of this intervention online.

Researchers enrolled 392 HF patients from 4 Veterans Affairs centers. To participate, patients were required to score less than 60 on the Kansas City Cardiomyopathy Questionnaire (KCCQ, which indicated impaired quality of life and functional status and a heavy symptom burden). Participants were then randomized 1:1 to receive usual care (n=197) or the intervention (n=187).

The intervention consisted of 3 components. The first component was a collaborative care team including a nurse coordinator, a cardiologist, a primary care doctor, and a psychiatrist that met weekly to make care change recommendations.

The second component was screening for depression and treatment as soon as it was indicated. This component was offered to participants who scored less than or equal to 10 on a depression screen and received 3 depression-related interventions.

Third, participants received telemonitoring daily via home-based equipment and self-care support. Equipment in the participants’ homes sent daily measurements (e.g., blood pressure, pulse, weight, etc.) to the healthcare team and participants with depression answered questions about their behavior and mood. The self-care programs had elements like medication reminders and educational programs.

There was no significant difference in baseline characteristics (KCCQ scores) between participants in the 2 arms. After one year, KCCQ scores in both arms improved significantly; however, there was no significant difference between the 2 arms.

Researchers also looked at secondary outcomes; there were significantly fewer deaths among participants in the intervention arm. Participants in the intervention arm who had been diagnosed with depression improved far more than similar patients in the control arm. The results showed no significant difference in hospitalization rates between the two arms.

The authors concluded, “This study adds to the existing literature by leaving open questions about the effectiveness and cost-effectiveness of disease management and telemonitoring for participants with HF.”