Cost Effectiveness and Quality of Life in Heart Failure Patients With Diabetes

Study Overview
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Brief Summary
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The purposes of this study are: to develop and test an integrated self care intervention for Heart Failure (HF)patients with Diabetes (DM) for its effects on patient outcomes including health related quality of life (HRQOL), physical function and health resource utilization. to assess the costs and cost effectiveness of the intervention. The intervention is designed to go beyond usual care of providing separate Heart Failure (HF) and Diabetes (DM) patient education by educating HF-DM patients on integrated self care and self management related to a HF-DM diet, HF-DM medication-taking behaviors, physical activity, and HF-DM symptom monitoring and management. An integrated self care intervention will compare HF-DM patients who receive the intervention with those who receive usual care-attention control for effects on patient outcomes,self care process measures, and health care utilization. If effective, the intervention will lead to improved self care, improved quality of life, and reduced health care resource use and costs. This study will facilitate greater understanding of self care within the context of two chronic illnesses and will lead directly to improved clinical practice and future research on comorbid self care in Heart Failure.

Detailed Description
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The investigators hypothesize that participants receiving the Heart Failure and Diabetes (HF-DM) self-care intervention will report greater Health Related Quality of Life (HRQOL) on the Minnesota Living with HF Questionnaire (MLHFQ), the Audit of Diabetes-dependent Quality of Life (ADDQoL), and the EuroQol (EQ5D) than the Usual Care (UC-AC) group at 6 months when controlling for age, gender, and NYHA Class. Secondly, that participants receiving the Heart Failure and Diabetes (HF-DM) self-care intervention will demonstrate improved physical function indicators (BNP levels, HgA1c, and 6MWT) at 6 months over the UC-AC group when controlling for age, gender, BMI, and NYHA Class and comorbid conditions. Thirdly, that participants receiving the Heart Failure and Diabetes (HF-DM) self-care intervention will exhibit greater improvement in: HF knowledge and DM knowledge than UC-AC at 6 months. Participants receiving the integrated HF-DM self-care intervention will report greater improvements in HF self-efficacy and DM self-efficacy over UC-AC at 6 months. HF-DM patients randomized to the integrated self-care intervention will exhibit greater improvements in overall HF and DM self-care behaviors and HF-DM diet and physical activity over UC-AC at 6 months. Lastly, that HF-DM patients who receive the integrated self-care intervention will exhibit less health resource use and associated costs(direct health care costs of provider visits, hospitalizations, ED visits, length of stay, and direct non-health care costs associated with the HRU and intervention) over the 6 months than those who receive UC-AC controlling for comorbidity and insurance status.

Official Title
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Cost Effectiveness and Quality of Life in Heart Failure Patients With Diabetes

Conditions
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Diabetes Mellitus, Heart Failure

Intervention / Treatment
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* Behavioral: HF DM self care
* Behavioral: Usual Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: hospital admission with a diagnosis of Heart Failure (HF) with Left Ventricular Systolic Dysfunction (LVSD) or diastolic dysfunction and concomitant Diabetes (DM) type II planned discharge from hospital to home setting NYHA Class II-IV On optimal HF regimen of care including ACE-Inhibitors or ARBs beta blocking agents, and diuretics if indicated by patient fluid status ambulatory able to read and write English acceptable cognitive screening test Exclusion Criteria: planned discharge to long term acute care presence of an insulin pump active foot ulcer presence of hemodynamically significant angina pectoris renal failure with hemodialysis planned cardiac surgery impaired cognition due to neurological comorbidity psychiatric diagnosis uncorrected visual or hearing problem uncorrected hearing or vision problems moderately severe depressive symptoms UNOS/ A status or ventricular assist device lack of telephone access

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: HF-DM Self Care<br>educational counseling intervention about integrated HF-DM self care outcomes | Behavioral: HF DM self care<br>* Education in monitoring signs and symptoms of Heart Failure and Diabetes as well as self care instruction<br>* Other names: HF-DM Self Care;Behavioral: Usual Care<br>* Educational materials on Heart Failure and diabetes at study enrollment. Full educational binder delivered at end of study.<br>|
| No Intervention: Usual Care<br>Usual Care provided by providers | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heart failure health related quality of life measures | As measured by Minnesota Living with Heart Failure Questionnaire (MLHFQ). | 6 months | 
| Diabetes health related quality of life measures | As measured by Audit of Diabetes - Dependent Quality of Life (ADDQOL). | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heart Failure and Diabetes (HF-DM) physical outcomes | BNP and HgA1c, and 6 minute walk test | 6 months | 
| Heart Failure Knowledge | As measured by the Atlanta Heart Failure Knowledge Test (AHFKT) | 6 months | 
| Health resource use | As measured by hospital and ED visits as well as contact with medical providers | 6 months | 
| Heart Failure (HF) self-efficacy | As measured by Self Care in Heart Failure Inventory Self Efficacy Scale | 6 months | 
| Heart Failure and Diabetes(HF-DM) self-care behaviors | As measured by activity calendars/logs, Self care in Heart failure Inventory subscales, and Summary of Diabetes Self Care Scale | 6 months | 
| Diabetes (DM) Knowledge | Michigan Diabetes Knowledge Test (MDKT) | 6 months | 
| Diabetes (DM) self efficacy | Measured by the Perceived Diabetes Self Management Scale (PDSMS) | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes, Heart Failure, Quality of Life, Self Care