Modest Improvement in Heart Failure Patients With Collaborative Care Intervention

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

A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs academic and safety-net health systems in Colorado. The study included 314 outpatients with symptomatic heart failure and reduced health status who were treated between August 2012 and April 2015.

Patients were randomized 1 to 1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or traditional care. CASA intervention includes collaborative system care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with patients’ primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician.

Of the 314 patients included in the study, 157 were in the intervention arm and 157 served as the control arm. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score, evaluating the primary outcome, improved 5.5 points in the intervention arm and 2.9 points in the control arm (95% CI, —1.3 to 6.6; P = .19). Among secondary outcomes, depressive symptoms and fatigue were reduced at 6 months with CASA (—0.29 [95% CI, –0.53 to –0.04], P = .02; and —0.30 [95% CI, –0.55 to –0.06], P = .02, respectively). Mortality at 12 months, however, was similar in both arms: 10 patients died receiving CASA and 13 patients died receiving traditional care.

Researchers found that the primary outcome of heart failure—specific health status did not significantly improve with the intervention. Among secondary outcomes, depressive symptoms and fatigue did show improvement within the study, but pain and shortness of breath did not. Thus, a symptom and psychosocial collaborative care intervention was not significantly better than traditional care for improving heart failure–specific health status.

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 care [published online February 26, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.8667.