BACKGROUND/RATIONALE:
In addition to medical treatment for heart failure (HF), a variety of non-pharmacological interventions have been demonstrated to benefit these patients. Some of these include systems for weight monitoring and medication reminders, exercise programs, and individually tailored evaluation and treatment plans with dietitians, social workers, psychologists, and nurse case managers. While many of these approaches have been shown to increase adherence to medication guidelines and result in decreased health care utilization, most rely heavily on a large team of specialized health care providers. It remains unknown whether or not an intervention with a lower intensity of specialized care using sophisticated automated computer tracking and Interactive Voice Response (IVR) techniques can impact the care of HF patients.

OBJECTIVE(S):
The primary hypothesis of this study is that Heart Failure Telephone Intervention (HearT-I) will decrease hospitalizations and clinic visits in the veteran population with heart failure.

METHODS:
The HearT-I intervention consists of three components: 1) computer-initiated medication refill and clinic appointment reminders; 2) IVR access to educational modules; and 3) weekly computer-initiated phone calls with a series of questions regarding weight and symptoms. Four hundred eighty-eight HF patients (NYHA class II-IV) will be randomized to HearT-I intervention vs. usual care. Upon enrollment, all patients will complete questionnaires assessing HF knowledge, behavior, self-efficacy, and perceptions of HF health care, and HF related Quality of Life (Kansas City Cardiomyopathy Questionnaire, KCCQ). Both groups also will receive a digital scale, educational materials, view an educational video about HF and perform a six-minute walk test. We will test the hypothesis that the HearT-I intervention will decrease health care utilization as measured by hospitalizations and unscheduled outpatient visits for HF over one year. Secondary endpoints include KCCQ score, patient satisfaction, adherence to medications, and general knowledge of heart failure and its management.

FINDINGS/RESULTS:
Patient enrollment began in April 2002, and 469 patients have been enrolled to date. Enrollment in this study will end July 31st, 2004. Patients were followed through August 15th, 2005.

IMPACT:
The care of HF patients is increasingly complex and consumes large amounts of health care resources, primarily due to frequent hospitalizations and a need for specialized health care providers. Moreover, a significant gap exists between what therapy is known to benefit patients with HF and the practical application of that therapy. If the HearT-I automated patient management system is found to benefit HF patients and decrease health care utilization it will have enormous implications in the delivery of HF care, especially since HearT-I patient management is independent of geographical location and therefore can be used to manage patients anywhere in the country.

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: Health Systems
DRE: Epidemiology
Keywords: Decision support, Telemedicine
MeSH Terms: none