EFFECT OF TELEPHONE INTERVENTION ON HEART FAILURE SELF CARE: RANDOMIZED CLINICAL TRIAL

2.50
Hdl Handle:
http://hdl.handle.net/10755/211461
Type:
Research Study
Title:
EFFECT OF TELEPHONE INTERVENTION ON HEART FAILURE SELF CARE: RANDOMIZED CLINICAL TRIAL
Abstract:
Background: Heart failure (HF) is a progressive disease characterized by declining function and quality of life (QoL), punctuated by acute exacerbations and frequent hospital admissions. Despite the considerable advances in HF treatment, this condition remains a growing health problem leading to astronomical costs as well as high morbidity and mortality. One third of HF patients are readmitted within 90 days for recurrent decompensation. National HF readmissions rate within 30-days is at 24%, ours is around 22%. Risk of readmission is often due to preventable factors, like non-adherence to drugs and diet, inadequate social support, and failure to seek prompt medical attention when symptoms worsen.  To prevent readmissions, early HF symptom recognition & treatment is needed, thus home Tele-Monitoring may be an effective way to do this. Study Aim(s): Primary aim of this multi-site randomized, controlled trial (RCT) is to determine the impact of a post-discharge, telephone intervention to recently hospitalized HF patients, regarding self-care/adherence, on reducing the incidence of all cause mortality or hospital readmissions (30-day /overall) compared to the “usual care” group receiving outpatient care by their primary care physician. A secondary aim is to assess the impact of the intervention on patient self-care/adherence by examining the effect on QoL and the role of multiple variables (socioeconomic, HC setting/system related, condition related, treatment and patient related). Theoretical Framework: Roy’s Adaptation Model helped frame the relationships among study variables using the concepts of Adaptation (Improved knowledge /Self-Care Maintenance / Management and improved QoL). Design: A sample of 525 eligible, HF patients hospitalized at a large teaching and community-based  hospital, are randomized in 1:1 ratio into a “usual care” control group or assigned to receive six months of a telephone intervention plus usual care. Measures: Baseline demographic data is collected from all subjects. They also complete the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure QoL; Patient Self-Assigned New York Heart Association (SA-NYHA) Class; the European Heart Failure Self-Care Behavior Scale (EHFScBS-9), and the Atlantic Heart Failure Knowledge Test. Intervention data points are at study enrollment, seven days post discharge, one month, three and six months.  The cohort is given the MLHFQ, Atlantic HF Knowledge Test and the EHFScBS-9 at 180 days. Nurses Knowledge of Heart Failure: We also hypothesized in the RCT that nurses’ knowledge and understanding about HF and self-care principles may vary significantly thus influencing the education they provide patients at discharge. A sample of 157 nurses completed the Nurses Knowledge of Heart Failure Survey, preceding the start of the trial. Results will be used to address the knowledge gap regarding HF management and will serve as a baseline for a future education intervention. Study Results Pending: This clinical trial is on-going. Intent-to-treat analysis will serve as primary analysis for all objectives. Descriptive statistics will be used to describe the study sample.  Categorical data will be compared by using χ2 analysis, and continuous variables analyzed using t test. Statistical significance was a P value < .05 for all tests, with 95% confidence intervals reported for all proportions.
Keywords:
Heart failure patients; telephone intervention
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5173
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleEFFECT OF TELEPHONE INTERVENTION ON HEART FAILURE SELF CARE: RANDOMIZED CLINICAL TRIALen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211461-
dc.description.abstractBackground: Heart failure (HF) is a progressive disease characterized by declining function and quality of life (QoL), punctuated by acute exacerbations and frequent hospital admissions. Despite the considerable advances in HF treatment, this condition remains a growing health problem leading to astronomical costs as well as high morbidity and mortality. One third of HF patients are readmitted within 90 days for recurrent decompensation. National HF readmissions rate within 30-days is at 24%, ours is around 22%. Risk of readmission is often due to preventable factors, like non-adherence to drugs and diet, inadequate social support, and failure to seek prompt medical attention when symptoms worsen.  To prevent readmissions, early HF symptom recognition & treatment is needed, thus home Tele-Monitoring may be an effective way to do this. Study Aim(s): Primary aim of this multi-site randomized, controlled trial (RCT) is to determine the impact of a post-discharge, telephone intervention to recently hospitalized HF patients, regarding self-care/adherence, on reducing the incidence of all cause mortality or hospital readmissions (30-day /overall) compared to the “usual care” group receiving outpatient care by their primary care physician. A secondary aim is to assess the impact of the intervention on patient self-care/adherence by examining the effect on QoL and the role of multiple variables (socioeconomic, HC setting/system related, condition related, treatment and patient related). Theoretical Framework: Roy’s Adaptation Model helped frame the relationships among study variables using the concepts of Adaptation (Improved knowledge /Self-Care Maintenance / Management and improved QoL). Design: A sample of 525 eligible, HF patients hospitalized at a large teaching and community-based  hospital, are randomized in 1:1 ratio into a “usual care” control group or assigned to receive six months of a telephone intervention plus usual care. Measures: Baseline demographic data is collected from all subjects. They also complete the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure QoL; Patient Self-Assigned New York Heart Association (SA-NYHA) Class; the European Heart Failure Self-Care Behavior Scale (EHFScBS-9), and the Atlantic Heart Failure Knowledge Test. Intervention data points are at study enrollment, seven days post discharge, one month, three and six months.  The cohort is given the MLHFQ, Atlantic HF Knowledge Test and the EHFScBS-9 at 180 days. Nurses Knowledge of Heart Failure: We also hypothesized in the RCT that nurses’ knowledge and understanding about HF and self-care principles may vary significantly thus influencing the education they provide patients at discharge. A sample of 157 nurses completed the Nurses Knowledge of Heart Failure Survey, preceding the start of the trial. Results will be used to address the knowledge gap regarding HF management and will serve as a baseline for a future education intervention. Study Results Pending: This clinical trial is on-going. Intent-to-treat analysis will serve as primary analysis for all objectives. Descriptive statistics will be used to describe the study sample.  Categorical data will be compared by using χ2 analysis, and continuous variables analyzed using t test. Statistical significance was a P value < .05 for all tests, with 95% confidence intervals reported for all proportions.en_GB
dc.subjectHeart failure patientsen_GB
dc.subjecttelephone interventionen_GB
dc.date.available2012-02-20T11:56:29Z-
dc.date.issued2012-02-20T11:56:29Z-
dc.date.accessioned2012-02-20T11:56:29Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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