Vanessa Blumer1, Anastasia Gayowsky2, Feng Xie3,4, Stephen J Greene1,5, Michelle M Graham6,7, Justin A Ezekowitz6, Richard Perez2, Dennis T Ko2,8, Lehana Thabane3,9, Faiez Zannad10, Harriette Gc Van Spall2,3,9,11. 1. Division of Cardiology, Duke University School of Medicine, Durham, North Carolina. 2. ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada. 3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 4. Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. 5. Duke Clinical Research Institute, Durham, North Carolina. 6. Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. 7. Mazankowski Heart Centre, University of Alberta, Edmonton, Alberta, Canada. 8. Sunnybrook Heart Centre, Toronto, Ontario, Canada. 9. Population Health Research Institute, Hamilton, Ontario, Canada. 10. Université de Lorraine, INSERM CIC-P 1433, and INSERM U1116 CHRU Nancy Brabois F-CRIN INI-CRCT, Nancy, France. 11. Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Abstract
AIMS: We assessed the effect of transitional care on patient reported outcomes (PROs) in women and men hospitalized for heart failure (HF). METHODS: In this sex-specific analysis of a cluster randomized trial in Canada, the effect of a patient-centered transitional care model was tested on prespecified PROs of discharge preparedness (B-PREPARED score, range 0-22), quality of transition (Care Transitions Measure-3 [CTM-3] score, 0-100), and health-related quality of life (HRQOL) (EQ-5D-5L, 0-1). RESULTS: Among 986 patients (47.4% women), B-PREPARED at 6 weeks was greater with intervention than usual care (mean difference [MD], 4.01 [95% confidence interval (CI), 2.90-5.12]; P < 0.001) with no sex differences (P sex interaction = 0.24). CTM-3 at 6 weeks was greater with intervention than usual care (MD, 10.52 [95% CI, 6.00-15.04]; P < 0.001), with no sex differences (P sex-interaction = 0.69). EQ-5D-5L was greater with intervention than usual care at discharge (MD, 0.17 [95% CI, 0.12-0.22]; P < 0.001), 6 weeks (MD, 0.06 [95% CI, 0.01-0.12]; P = 0.02), and 6 months (MD, 0.05 [95% CI, -0.01-0.12]; P = 0.09), although the 6-month difference was not statistically significant. At discharge, women reported lower EQ-5D-5L but experienced significantly greater treatment benefit than men (P sex-interaction = 0.02). Treatment effect on EQ-5D-5L was numerically greater in women than men at 6 weeks and 6 months, but there were no significant sex differences (P sex-interaction 0.18 and 0.19, respectively). CONCLUSION: A patient-centered transitional care model improved discharge preparedness, transition quality, and HRQOL in the weeks following HF hospitalization, with effects largely consistent in women and men. However, women reported lower HRQOL and experienced greater treatment benefit than men at hospital discharge. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02112227. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
RCT Entities:
AIMS: We assessed the effect of transitional care on patient reported outcomes (PROs) in women and men hospitalized for heart failure (HF). METHODS: In this sex-specific analysis of a cluster randomized trial in Canada, the effect of a patient-centered transitional care model was tested on prespecified PROs of discharge preparedness (B-PREPARED score, range 0-22), quality of transition (Care Transitions Measure-3 [CTM-3] score, 0-100), and health-related quality of life (HRQOL) (EQ-5D-5L, 0-1). RESULTS: Among 986 patients (47.4% women), B-PREPARED at 6 weeks was greater with intervention than usual care (mean difference [MD], 4.01 [95% confidence interval (CI), 2.90-5.12]; P < 0.001) with no sex differences (P sex interaction = 0.24). CTM-3 at 6 weeks was greater with intervention than usual care (MD, 10.52 [95% CI, 6.00-15.04]; P < 0.001), with no sex differences (P sex-interaction = 0.69). EQ-5D-5L was greater with intervention than usual care at discharge (MD, 0.17 [95% CI, 0.12-0.22]; P < 0.001), 6 weeks (MD, 0.06 [95% CI, 0.01-0.12]; P = 0.02), and 6 months (MD, 0.05 [95% CI, -0.01-0.12]; P = 0.09), although the 6-month difference was not statistically significant. At discharge, women reported lower EQ-5D-5L but experienced significantly greater treatment benefit than men (P sex-interaction = 0.02). Treatment effect on EQ-5D-5L was numerically greater in women than men at 6 weeks and 6 months, but there were no significant sex differences (P sex-interaction 0.18 and 0.19, respectively). CONCLUSION: A patient-centered transitional care model improved discharge preparedness, transition quality, and HRQOL in the weeks following HF hospitalization, with effects largely consistent in women and men. However, women reported lower HRQOL and experienced greater treatment benefit than men at hospital discharge. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02112227. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Entities:
Keywords:
heart failure; quality of life; transitional care; women
Authors: Monica Parry; Harriette G C Van Spall; Kerri-Anne Mullen; Sharon L Mulvagh; Christine Pacheco; Tracey J F Colella; Marie-Annick Clavel; Shahin Jaffer; Heather J A Foulds; Jasmine Grewal; Marsha Hardy; Jennifer A D Price; Anna L E Levinsson; Christine A Gonsalves; Colleen M Norris Journal: CJC Open Date: 2022-04-19