Randomized, controlled trial to improve self-care in patients with heart failure living in rural areas

Kathleen Dracup, Debra K. Moser, Michele M. Pelter, Thomas S Nesbitt, Jeffrey Southard, Steven M. Paul, Susan Robinson, Lawton S. Cooper

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)256-264
Number of pages9
JournalCirculation
Volume130
Issue number3
DOIs
StatePublished - Jul 15 2014

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Self Care
Randomized Controlled Trials
Heart Failure
Nurses
Control Groups
Hospitalization
Systolic Heart Failure
Education
Mortality
Clinical Trials

Keywords

  • clinical trials as topic
  • heart failure
  • patient education as topic

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Randomized, controlled trial to improve self-care in patients with heart failure living in rural areas. / Dracup, Kathleen; Moser, Debra K.; Pelter, Michele M.; Nesbitt, Thomas S; Southard, Jeffrey; Paul, Steven M.; Robinson, Susan; Cooper, Lawton S.

In: Circulation, Vol. 130, No. 3, 15.07.2014, p. 256-264.

Research output: Contribution to journalArticle

Dracup, Kathleen ; Moser, Debra K. ; Pelter, Michele M. ; Nesbitt, Thomas S ; Southard, Jeffrey ; Paul, Steven M. ; Robinson, Susan ; Cooper, Lawton S. / Randomized, controlled trial to improve self-care in patients with heart failure living in rural areas. In: Circulation. 2014 ; Vol. 130, No. 3. pp. 256-264.
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abstract = "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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N2 - 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.

AB - 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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