Marie Bakitas|J. Nicholas Dionne?Odom|Deborah Ejem|Rachel Wells|Andrés Azuero|Macy Stockdill|Konda Keebler|Elizabeth Sockwell|Sheri Tims|Sally Engler|Karen Steinhauser|Elizabeth Kvale|Raegan W. Durant|Rodney Tucker|Kathryn L. Burgio|José Tallaj|Keith M. Swetz|Salpy V. Pamboukian
Effect of an Early Palliative Care Telehealth Intervention vs Usual Care on Patients With Heart Failure
University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|Durham VA Medical Center|Center for Innovation|Duke University|The University of Texas at Austin|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|Geriatric Research Education and Clinical Center|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham
h3importanceh3 national guidelines recommend early palliative care patients advanced heart failure disproportionately affects rural minority populations h3objectiveh3 determine effect early palliative care telehealth intervention 16 weeks quality life mood global health pain resource use patients advanced heart failure h3design setting participantsh3 singleblind intervention vs usual care randomized clinical trial conducted october 1 2015 may 31 2019 among 415 patients 50 years older new york heart association class iii iv heart failure american college cardiology stage c heart failure large southeastern us academic tertiary medical center veterans affairs medical center serving high proportions rural dwellers african american individuals h3interventionsh3 enable chfpc educate nurture advise life ends comprehensive heartcare patients caregivers intervention comprises inperson palliative care consultation 6 weekly nursecoach telephonic sessions 2040 minutes monthly followup 48 weeks h3main outcomes measuresh3 primary outcomes quality life measured kansas city cardiomyopathy questionnaire kccq score range 0100 higher scores indicate better perceived health status clinical summary scores 50 considered fairly good quality life functional assessment chronic illness therapypalliative14 facitpal14 score range 056 higher scores indicate better quality life mood measured hospital anxiety depression scale hads 16 weeks secondary outcomes global health patient reported outcome measurement system global health pain patient reported outcome measurement system pain intensity interference resource use hospital days emergency department visits h3resultsh3 415 participants 221 men baseline mean sd age 638 85 years randomized enable chfpc n 208 usual care n 207 226 545 african american 108 260 lived rural area 190 458 highschool education less mean sd baseline kccq score 526 210 week 16 mean se kccq score improved 39 13 points intervention group vs 23 12 usual care group difference 16 se 17idi 007 95 ci 009 024 mean se facitpal14 score improved 14 06 points intervention group vs 02 05 points usual care group difference 12 se 08idi 012 95 ci 003 028 relevant betweengroup differences mood hadsanxietyidi 002 95 ci 020 016 hadsdepressionidi 009 95 ci 024 006 h3conclusions relevanceh3 randomized clinical trial majority african american sample baseline good quality life demonstrate improved quality life mood 16week early palliative care telehealth intervention however pain intensity interference secondary outcomes demonstrated clinically important improvement h3trial registrationh3 clinicaltrialsgov identifiernct02505425