BACKGROUND: Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses. METHODS:Patients with a general practice (GP) diagnosis of HF were randomized to usual care (UC) or UC and telephone support intervention (UC+I) using a cluster design involving 143 GPs throughout Australia. Patients were followed up for 12 months. The primary endpoint was the Packer clinical composite score. Secondary endpoints included hospitalization for any cause, death or hospitalization, as well as HF hospitalization. RESULTS:Four hundred and five patients were randomized to CHAT. Patients were well matched at baseline for key demographic variables. The primary endpoint of the Packer score was not different between the two groups (P = 0.98), although more patients improved with UC+I. There were fewer patients hospitalized for any cause (74 vs. 114, adjusted HR 0.67 [95% CI 0.50-0.89], P = 0.006) and who died or were hospitalized (89 vs. 124, adjusted HR 0.70 [95% CI 0.53-0.92], P = 0.011), in the UC+I vs. UC group. HF hospitalizations were reduced with UC+I (23 vs. 35, adjusted HR 0.81 [95% CI 0.44-1.38]), although this was not significant (P = 0.43). There were 16 deaths in the UC group and 17 in the UC+I group (P = 0.43). CONCLUSIONS: Although no difference was observed in the primary endpoint of CHAT (Packer composite score), UC+I significantly reduced the number of HF patients hospitalized among a rural and remote cohort. These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients.
RCT Entities:
BACKGROUND:Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses. METHODS:Patients with a general practice (GP) diagnosis of HF were randomized to usual care (UC) or UC and telephone support intervention (UC+I) using a cluster design involving 143 GPs throughout Australia. Patients were followed up for 12 months. The primary endpoint was the Packer clinical composite score. Secondary endpoints included hospitalization for any cause, death or hospitalization, as well as HF hospitalization. RESULTS: Four hundred and five patients were randomized to CHAT. Patients were well matched at baseline for key demographic variables. The primary endpoint of the Packer score was not different between the two groups (P = 0.98), although more patients improved with UC+I. There were fewer patients hospitalized for any cause (74 vs. 114, adjusted HR 0.67 [95% CI 0.50-0.89], P = 0.006) and who died or were hospitalized (89 vs. 124, adjusted HR 0.70 [95% CI 0.53-0.92], P = 0.011), in the UC+I vs. UC group. HF hospitalizations were reduced with UC+I (23 vs. 35, adjusted HR 0.81 [95% CI 0.44-1.38]), although this was not significant (P = 0.43). There were 16 deaths in the UC group and 17 in the UC+I group (P = 0.43). CONCLUSIONS: Although no difference was observed in the primary endpoint of CHAT (Packer composite score), UC+I significantly reduced the number of HF patients hospitalized among a rural and remote cohort. These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients.
Authors: Jill Howie-Esquivel; Maureen Carroll; Eileen Brinker; Helen Kao; Steven Pantilat; Karen Rago; Teresa De Marco Journal: Cardiol Res Date: 2015-02-09
Authors: Javier Bermejo; Raquel Yotti; Rocío García-Orta; Pedro L Sánchez-Fernández; Mario Castaño; Javier Segovia-Cubero; Pilar Escribano-Subías; José Alberto San Román; Xavier Borrás; Angel Alonso-Gómez; Javier Botas; María G Crespo-Leiro; Sonia Velasco; Antoni Bayés-Genís; Amador López; Roberto Muñoz-Aguilera; Eduardo de Teresa; José R González-Juanatey; Arturo Evangelista; Teresa Mombiela; Ana González-Mansilla; Jaime Elízaga; Javier Martín-Moreiras; José M González-Santos; Eduardo Moreno-Escobar; Francisco Fernández-Avilés Journal: Eur Heart J Date: 2018-04-14 Impact factor: 29.983
Authors: Manuel Gonzalez Garcia; Farhad Fatehi; Nazli Bashi; Marlien Varnfield; Pupalan Iyngkaran; Andrea Driscoll; Christopher Neil; David L Hare; Brian Oldenburg Journal: Clin Med Insights Cardiol Date: 2019-07-10