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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Randomized, controlled trial to improve self-care in patients with heart failure living in rural areas
Kathleen Dracup1, Debra K Moser2, Michele M Pelter2
1From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.). kathy.dracup@nursing.ucsf.edu.
Insights
A study on heart failure (HF) patients in rural areas found that a nurse-led education program did not reduce hospitalizations or cardiac deaths. However, the LITE intervention showed a significant decrease in cardiac mortality compared to usual care.
Area of Science:
- Cardiology
- Public Health
- Nursing Education
Background:
- Rural populations with heart failure (HF) face challenges accessing cardiac services.
- A randomized clinical trial was conducted to assess an educational intervention's impact on HF rehospitalization and cardiac death.
Purpose of the Study:
- To evaluate the effectiveness of a self-care educational intervention for rural heart failure patients.
- To compare the impact of two intervention intensities (LITE vs. PLUS) against usual care.
Main Methods:
- 602 patients with HF were randomized into three groups: control, Fluid Watchers LITE, and Fluid Watchers PLUS.
- Interventions involved face-to-face education and varying levels of nurse follow-up calls.
- The primary composite endpoint was HF rehospitalization or cardiac death over two years.
Main Results:
- No significant difference in the composite outcome of HF rehospitalization or cardiac death was observed across the three groups (P=0.06).
- Patients in the LITE group experienced significantly reduced cardiac mortality (7.5%) compared to the control group (17.7%; P=0.003).
- The PLUS group did not show a significant difference in cardiac mortality compared to the control group.
Conclusions:
- A face-to-face educational intervention did not significantly reduce the combined endpoint of cardiac death or HF hospitalization.
- Increasing the frequency of nurse contact in the PLUS group did not yield better outcomes than the LITE group or usual care.
Background:
Patients with heart failure (HF) who live in rural areas have less access to cardiac services than patients in urban areas. We conducted a randomized, clinical trial to determine the impact of an educational intervention on the composite end point of HF rehospitalization and cardiac death in this population.
Methods And Results:
Patients (n=602; age, 66±13 years; 41% female; 51% with systolic HF) were randomized to 1 of 3 groups: control (usual care), Fluid Watchers LITE, or Fluid Watchers PLUS. Both intervention groups included a face-to-face education session delivered by a nurse focusing on self-care. The LITE group received 2 follow-up phone calls, whereas the PLUS group received biweekly calls (mean, 5.3±3.6; range, 1-19) until the nurse judged the patient to be adequately trained. Over 2 years of follow-up, 35% of patients (n=211) experienced cardiac death or hospitalization for HF, with no difference among the 3 groups in the proportion who experienced the combined clinical outcome (P=0.06). Although patients in the LITE group had reduced cardiac mortality compared with patients in the control group over the 2 years of follow-up (7.5% and 17.7%, respectively; P=0.003), there was no significant difference in cardiac mortality between patients in the PLUS group and the control group.
Conclusions:
A face-to-face education intervention did not significantly decrease the combined end point of cardiac death or hospitalization for HF. Increasing the number of contacts between the patient and nurse did not significantly improve outcome.
Clinical Trial Registration:
http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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