A Randomized Trial of Mobile Health Support for Heart Failure Patients and Their Informal Caregivers

Abstract

Background Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers’ efforts. Objectives To determine whether automated feedback to caregivers of chronic heart failure (HF) patients impacts caregiving burden and assistance with self-management. Research Design Randomized comparative effectiveness trial. Subjects 369 HF patients were recruited from a VA healthcare system. All patients participated with a “CarePartner” or informal caregiver outside their household. Intervention Patients randomized to “standard mHealth” received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. “mHealth+CP” patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners. Measures At baseline, six- and twelve months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support. Results mHealth+CP CarePartners reported less caregiving strain than controls at both 6- and 12-months (both p≤.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (p ≤.03 for interactions between arm and baseline strain/depression at both endpoints). While most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all p<.05). mHealth+CP CarePartners reported more frequently attending patients’ medical visits at six months (p=.049) and greater involvement in medication adherence at both endpoints (both p≤.032). Conclusions When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners’ engagement in self-care.

A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes

“…The 12 interventions included variable numbers of sessions in which the components were delivered; ranging from one home visit to deliver equipment (Kenealy et al, 2015) to weekly telephone calls for 12 months. (Piette et al, 2015) The time spent during a session ranged from a 15 minute phone call (Srisuk et al, 2015) to a 90 minute phone call (Piamjariyakul et al, 2015) with most face-to-face sessions lasting approximately 60 minutes (or multiples of this).…”

“…Countries where interventions were tested included the United States, (Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Piamjariyakul et al, 2015;Piette et al, 2008;Piette et al, 2015) Sweden, (Ågren et al, 2015;Agren et al, 2012) New Zealand, (Kenealy et al, 2015) Iran, (Hasanpour-Dehkordi et al, 2016) and Thailand. (Srisuk et al, 2015) Settings where the intervention was initiated or where the majority of the interventions were delivered included hospitals, (Agren et al, 2012;Bull et al, 2000;Hasanpour-Dehkordi et al, 2016;Kenealy et al, 2015;Piette et al, 2008;Schwarz et al, 2008) clinics, (Ågren et al, 2015;Agren et al, 2012;Dunbar et al, 2013;Piamjariyakul et al, 2015;Srisuk et al, 2015) home, (Agren et al, 2012) a U.S. Veterans Administration (clinic or hospital), (Piette et al, 2008;Piette et al, 2015) and in a clinical research center. (Dunbar et al, 2005) Two studies (Agren et al, 2012;Piette et al, 2008) included multiple sites to support the transition from hospital to home or increase recruitment.…”

“…The 12 interventions aligned into three delivery contexts -those which could be categorized as face-to-face; (Ågren et al, 2015;Agren et al, 2012;Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) telephone; (Piamjariyakul et al, 2015) or telehealth interventions (see Table 2). (Kenealy et al, 2015;Piette et al, 2008;Piette et al, 2015;Schwarz et al, 2008) Most face-to-face interventions also used some form of technology including DVD/video, (Bull et al, 2000;Dunbar et al, 2005;Srisuk et al, 2015) website, (Agren et al, 2012) or phone calls (Ågren et al, 2015;Dunbar et al, 2005;Dunbar et al, 2013;Srisuk et al, 2015) blurring the line between "high touch" and "high tech" modalities. It appears that all the studies were investigator-initiated and led.…”

“…Patient self-care at 3 and 6 months (Srisuk et al, 2015) Carers attending visits (Piette et al, 2015) Patient self-care at 6 months (during intervention) (Kenealy et al, 2015) Patient medication adherence (Dunbar et al, 2013) Carer tasks Self-care for Patient…”

“…Patient/Carer depression at 6 months (Kenealy et al, 2015;Piamjariyakul et al, 2015;Piette et al, 2015) Patient social support at 6 months (Piamjariyakul et al, 2015) Carer confidence (Piamjariyakul et al, 2015) Patient anxiety (Kenealy et al, 2015) Carer strain (Piette et al, 2015) Patient depression at 3 months, (Dunbar et al, 2005;Schwarz et al, 2008) Patient/Carer depression at 12 months (Ågren et al, 2015;Agren et al, 2012) and 24 months (Liljeroos et al, 2015) Carer social support at 3 months (Schwarz et al, 2008) Carer burden (Agren et al, 2012;Agren et al, 2015) Depression affective, and health services utilization). In the main outcome papers of the complete studies only one paper reported null findings on all outcomes.…”