innovative care of older adults with chronic heart failure: a comparative effectiveness clinical trial (i-coach)

Conditions: Heart Failure

Summary: an estimated 6.5 million adults in the u.s. have heart failure (hf) and the prevalence is increasing. hf is characterized by poor quality of life but this is amenable to self-management. however, the amount of support available from providers to help manage complications is far beyond what is feasible. the complex needs of these patients require a new vision for delivery of health care services, such as an mhealth management model. mhealth technologies such as blue-tooth enabled bp, heart rate, weight, and pulse oximetry remote monitoring permit sharing of immediate biometric data and video messages with providers and instantaneous feedback to patients before symptom crises, that is, when and where patients need it.

an estimated 6.5 million adults in the u.s. have heart failure (hf) and the prevalence is increasing. hf is characterized by poor quality of life but this is amenable to self-management. however, the amount of support available from providers to help manage complications is far beyond what is feasible. the complex needs of these patients require a new vision for delivery of health care services, such as an mhealth management model. mhealth technologies such as blue-tooth enabled bp, heart rate, weight, and pulse oximetry remote monitoring permit sharing of immediate biometric data and video messages with providers and instantaneous feedback to patients before symptom crises, that is, when and where patients need it. this is a single-blinded comparative effectiveness randomized controlled trial conducted in a real-world setting. a sample of 400 dyads, that is older patients with hf (\>55 years) and their caregivers, will be recruited from a large medical center and randomly assigned to one of two arms: 200 dyads to a provider-directed model or 200 dyads to the mhealth management model. the provider-directed management model is the current care standard for patients with hf; care delivery consists of office and emergency visits, with telephone or in person communications. the standard of care will be augmented by providing home equipment kits with weight scale, blood pressure, pulse oximetry devices and a log to record data. the mhealth care management model consists of real time bio-monitoring kits and telemedicine visits using a secure wireless gateway with a cloud-based clinician portal connected to a bluetooth-paired android tablet. daily readings are transmitted to a 24-hour rn call center and triaged per protocols. outcomes informed a prior by community stakeholders to be most important at the patient, caregiver, and health systems-levels will be collected and compared at baseline, 3- and 6- months: 1) for the patient: self-care of hf; confidence and self-efficacy to manage care, symptoms, medications and treatments; hf knowledge; mental and physical health, health distress, informational support, equipment usability, and quality of life. 2) for the caregiver: caregiver burden and health. 3) for the health system: patient satisfaction, hospital, emergency \& provider visits, and mortality. differential benefits for subsets of participants will be evaluated according to patient characteristics (socio-demographical, rurality, etc.). evaluation of mediation variables will enhance our understanding of underlying processes. this research has the potential to revolutionize care for high-cost and high-need patients such as those with hf.

Eligibility criteria:
inclusion criteria: * adults aged \> 55 years with hf (documented in medical record). * has capacity to understand informed consent. * able to stand (briefly) without assistance. * has a designated caregiver. * agrees to be followed (treated) by uams physician/provider for 6 months after discharge. exclusion criteria: * speaks a language other than english or spanish. * active psychosis or other severe cognitive disorder that interferes with capacity to understand and comply with study procedures. * a history of drug or alcohol abuse in the past 90 days (documented in medical record).