Can Collaborative Care Intervention Improve Patient Health Status in Chronic Heart Failure?
A recent study published in JAMA Internal Medicine (online February 26, 2018; doi:10.1001/jamainternmed.2017.8667) compared the effects of a collaborative care intervention vs usual care on health status of patients with chronic heart failure.
Despite many patients with chronic heart failure receiving conventional therapy, reduced health status is well documented in this population.
David B Bekelman, MD, MPH, department of veterans affairs, Eastern Colorado Health Care System (Denver, CO), and colleagues conducted an investigation to determine whether a symptom and psychosocial collaborative care intervention could improve heart failure-specific status, depression, and symptom burden in patients with heart failure. The single-blind, 2-arm, randomized trial enrolled 314 adult outpatients with symptomatic heart failure and reduced health status from 2012 through 2015. Patients were randomized (1:1) to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention (n = 157) or usual care (n = 157). The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker.
The primary outcome of the study was patient-reported heart failure-specific health status, which was measured by the difference in change scores on the Kansas City Cardiomyopathy Questionnaire at 6 months. Among the secondary outcomes were depression, anxiety, overall symptom distress, specific symptoms, number of hospitalizations, and mortality.
Results of the study showed that at 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the CASA arm compared with 2.9 points in the usual care arm (difference, 2.6; 95% CI, -1.3 to 6.6; P = .19).
Among the secondary outcomes, depressive symptoms and fatigue improved at 6 months for those in the CASA arm, but there were no significant changes in overall symptom distress, pain, shortness of breath, or number of hospitalizations between the two intervention arms.
Additionally, researchers reported that mortality at 12 months was comparable in both arms.
Dr Bekelman and colleagues concluded that the primary outcome of heart failure-specific health status did not change significantly with the collaborative care intervention. “A symptom and psychosocial collaborative care intervention is not significantly better than usual care for improving heart failure-specific health status,” they wrote.—Zachary Bessette