Collaborative Care Intervention Did Not Improve Health Status of Patients With Heart Failure

In a study recently published in JAMA Internal Medicine, researchers sought determine whether a symptom and psychosocial collaborative care intervention would improve heart failure—specific health status, depression, and symptom burden in patients with heart failure.

Researchers created a single-blind, double-arm, multisite randomized trial that was conducted at Department of Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status. Patients were recruited and enrolled in the trial between August 2012 and April 2015.

Within the trial, patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention meant that collaborative symptom care was provided by a nurse, and psychosocial care was provided by a social worker, both of whom worked with the patients’ primary care physicians.

Of the 314 patients randomized (157 to the intervention arm and 157 to the control arm), 67 were women and 247 were men. The mean age of participants was 65.5 years, and 178 (56.7%) had reduced ejection fraction. The primary outcome of the study was patient-reported heart failure—specific health status, as measured by a difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range 0-100) at 6 months.

Secondary outcomes included:

• Depression (measured by the 9-item Patient Health Questionnaire)
• Anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire)
• Overall symptom distress (measured by the General Symptom Distress Scale)
• Specific symptoms such as pain, fatigue, and shortness of breath
• Number of hospitalizations
• Mortality

At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm, and 2.9 points in the control arm (2.6; 95% CI, —1.3 to 6.6; P = .19). In terms of secondary outcomes, depressive symptoms and fatigue improved at 6 months in the intervention arm, effect size of —.29 (95% CI: –.53 to –.004, P = .02) for depressive symptoms and —.30 (95% CI, -.55 to –.006, P = .02) for fatigue, respectively.

Overall, however, the researchers found that the CASA intervention did not significantly demonstrate improved heart failure—specific health status. Conversely, secondary outcomes of depression and fatigue did improve.

Reference

Bekelman D, Allen L, McBryde C, et al. Effect of a collaborative care intervention vs usual care on health status of patients with chronic heart failure. JAMA Intern Med. 2018;178(4):511-519. doi:10.1001/jamainternmed.2017.8667