Congestive heart failure adherence redesign trial: a pilot study
Authors: James E Calvin Jr
Lynda H Powell
Elizabeth Avery
Ashvarya Mangla
Rami Doukky
DeJuran Richardson
Journal: BMJ Open (2014)
Discipline: CLINICAL MEDICINE
Keywords: QUALITATIVE RESEARCH.
Affiliations: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA Department of Internal Medicine, OSF St. Francis Medical Center, Peoria, Illinois, USA., Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA., Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA., Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA Department of Mathematics, Lake Forest College, Lake Forest, Illinois, USA., Department of Medicine, University of Western Ontario, London, Ontario, Canada.

Abstract:  Objective: Heart failure (HF) continues to be a leading cause of hospital admissions, particularly in underserved patients. We hypothesised that providing individualised self-management support to patients and feedback on use of evidence-based HF therapies (EBT) to physicians could lead to improvements in care and decrease hospitalisations. To assess the feasibility of conducting a larger trial testing the efficacy of this dual-level intervention, we conducted the Congestive Heart failure Adherence Redesign Trial Pilot (CHART-P), a proof-of-concept, quasi-experimental, feasibility pilot study. Setting: A large tertiary care medical centre in Chicago. Participants: Low-income patients (&lt;US$30,000/year) hospitalised for exacerbation of systolic HF (ejection fraction ‚â?0%) and their physicians. Twenty physicians and 33 patients were enrolled, of whom 23 patients completed the study. Interventions: Physicians received HF guidelines and periodic individualised feedback on their adherence to EBT. Patients received HF education, support and self-management training for diet and medication adherence by a trained nurse through 11 interactive sessions over a 4-month period. Evaluations were conducted pre-enrolment and 1 month postintervention completion. Outcome measures: Feasibility was assessed by the ability to deliver intervention to patients and physicians. Exploratory outcomes included changes in medication and sodium intake for patients and adherence to EBT for physicians. Results: Eighty-seven per cent and 82% of patients received &gt;80% of interventions at 1 month and by study completion, respectively. Median sodium intake declined (3.5 vs 2.0 g; p&lt;0.01). There was no statistically significant change in medication adherence based on electronic pill cap monitoring or the Morisky Medication Adherence Scale (MMAS); however, there was a trend towards improved adherence based on MMAS. All physicians received timely intervention. Conclusions: This pilot study demonstrated that the protocol was feasible. It provided important insights about the need for intervention and the difficulties in treating patients with a variety of psychosocial problems that undercut their effective care. 

Retracted: No

PubPeer comments:
 Mangla et al cite and discuss findings from a 2008 paper by Paterna et al published in Clinical Science that has been found to contain data duplicated in a later study from the same author group published in the Journal of Cardiac Failure (Parinnello 2009). Data from both these studies were contained in a 2012 systematic review published in BMJ Heart journal that was later retracted (Aug 21, 2012) due to the inability of the study group to provide the original data to verify the duplicate data issues due to a u201ccomputer failureu201d. u2028Additional PubPeer posts for the specific papers are available: https: pubpeer.com publications E03BB72DBAA939C61082F4608D558B https: pubpeer.com publications B24491C479E0C003418D1F1CBECE07 A complete blog of the story leading to retraction of the BMJ Heart systematic review is available here: https: www.cebm.net 2019 02 salt-reduction-in-heart-failure-where-has-the-uncertainty-come-from ,