Telephone Support to Rural and Remote Patients with Heart Failure: The Chronic Heart Failure Assessment by Telephone (CHAT) study

Abstract

SUMMARYBackground: 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,, P = 0.006) and who died or were hospitalized (89 vs. 124,, 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.

Effectiveness of Mobile Phone-Based Interventions for Improving Health Outcomes in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis

“…Four studies were rated to have a low RoB [27,29,31,32]. Three out of the eight studies were rated to have a high RoB [26,28,33], and the other studies were rated to have an unclear RoB [30]. Random sequence generation was reported in five studies [27,29,[31][32][33].…”

“…As shown in Table 1, eight RCTs with a total of 2534 patients were included in this systematic review. Seven studies were conducted in the United States and Europe [26][27][28][29][30][31][32], as well as one in China [33]. Of the patients, 1331 were allocated to the intervention group and 1203 to the control group.…”

“…Five studies [26,28,30,32,33] describe the voice call intervention. The intervention period varied from 1 month to 24 months.…”

“…Voice call cycles were regularly communicated with HF patients during the study period in three studies [28,30,32]; however, in two studies, the frequency varied widely from only once to frequently [26,33]. Voice call time was used to talk directly to patients in four studies [28,30,32,33], but in the other study, family members and community agencies were contacted [26]. Nurse-led voice call interventions were conducted in two studies [28,30].…”

Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review

“…With regard to providing access to healthcare professionals in remote/rural areas, tele-visits/video conferencing can provide a forum for patients to access nursing and midwifery care in a timely manner and reduces costs of travelling for all concerned [116, 117]. For example, in rural Australia, specialist cardiovascular nurses provided additional telephone supports which found a reduction in the number of hospitalisations for patients with heart failure [118]. …”