Heart failure (HF) places an enormous burden on patients, their families, health care systems and society. Readmission for HF occurs within 30 days following 20 percent of discharges from the VA system with similar rates in the Medicare health care system. Few studies have examined whether chronic heart failure (HF) outcomes can be improved by increasing patient engagement (known as activation) in care and capabilities for self-care management.
The objective was to determine the efficacy of a patient activation (Heart PACT) intervention compared to usual care on activation, self-care management, hospitalizations and emergency room visits in patients with HF.
This study employed a randomized, 2-group, repeated-measures design at a single VA site. Following consent, 84 participants were stratified by activation level and randomly assigned to usual care (n = 41), or usual care plus the Heart PACT intervention (n = 43). The primary outcomes and measures were patient activation using the Patient Activation Measure (PAM); self-management using the Self-Care of Heart Failure Index (SCHFI) and the Medical Outcomes Study (MOS) Specific Adherence Scale; and hospitalizations and emergency room visits using self-report and VA databases. The Heart PACT intervention consisted of individual meetings and phone contacts over 6 months. The intervention leaders collaborated with patients to increase activation and improve HF self-management behaviors, such as adhering to medications and implementing health behavior goals. The primary analyses were 2 (group: control vs. intervention) x 3 (time) repeated measures analyses of variance.
Participants were primarily male (99%), Caucasian (77%), and NYHA III (52%). The mean age was 66 years (SD 11) and 71% reported 3 or more comorbidities. The intervention group compared to the usual care group showed a significant increase in activation/PAM scores from baseline to 6 months (significant group by time interaction, F=3.73, p=.03). No significant group by time interactions were found for the SCHFI scales. Although the baseline MOS Specific Adherence Scale mean was lower in the intervention group, results showed a significant group by time effect (F=7.48, p = .001) with the intervention group improving more over time. Participants in the intervention group had fewer hospitalizations compared to the usual care group when the baseline activation/PAM level was low or high. Participants in the intervention group compared to usual care with a medium level of activation showed more hospitalizations at 3 and 6 months.
Patient activation can be improved through targeted intervention. Further research needs to be done regarding the causal links between activation, self-management, and hospitalizations. The patient activation model has the potential to change approaches to tailored patient education for self-management in heart failure.
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