Randomized Controlled Trial of Telephone Case Management in Hispanics of Mexican Origin With Heart Failure

doi:10.1016/j.cardfail.2006.01.005

Journal of Cardiac Failure

Volume 12, Issue 3, April 2006, Pages 211-219

https://doi.org/10.1016/j.cardfail.2006.01.005 Get rights and content

Abstract

Background

Disease management is effective in the general population, but it has not been tested prospectively in a sample of solely Hispanics with heart failure (HF). We tested the effectiveness of telephone case management in decreasing hospitalizations and improving health-related quality of life (HRQL) and depression in Hispanics of Mexican origin with HF.

Methods and Results

Hospitalized Hispanics with chronic HF (n = 134) were enrolled and randomized to intervention (n = 69) or usual care (n = 65). The sample was elderly (72 ± 11 years), New York Heart Association class III/IV (81.3%), and poorly educated (78.4% less than high school education). Most (55%) were unacculturated into US society. Bilingual/bicultural Mexican-American registered nurses provided 6 months of standardized telephone case management. Data on hospitalizations were collected from automated systems at 1, 3, and 6 months after the index hospital discharge. Health-related quality of life and depression were measured by self-report at enrollment, 3, and 6 months. Intention to treat analysis was used. No significant group differences were found in HF hospitalizations, the primary outcome variable (usual care: 0.49 ± 0.81 [CI 0.25–0.73]; intervention: 0.55 ± 1.1 [CI 0.32–0.78] at 6 months). No significant group differences were found in HF readmission rate, HF days in the hospital, HF cost of care, all-cause hospitalizations or cost, mortality, HRQL, or depression.

Conclusion

These results have important implications because of the current widespread enthusiasm for disease management. Although disease management is effective in the mainstream HF patient population, in Hispanics this ill, elderly, and poorly educated, a different approach may be needed.

Section snippets

Methods

Two bilingual/bicultural Mexican-American registered nurses with special training in HF provided the intervention. Telephone case management was hypothesized to decrease hospitalizations (acute care use) and improve HRQL and depression. Heart failure rehospitalization was the primary outcome variable. Other outcome variables were all-cause hospitalizations, days in the hospital (HF and all-cause), multiple readmissions (more than 1 in 3 or 6 months), acute care costs (HF and all-cause), and

Sample

With repeated measures, a sample size of 63 per group was estimated to provide at least 80% power at the 0.05 significance level to detect a small to medium effect of the intervention on HF rehospitalizations; a moderate effect could be detected with 55 per group.¹⁶ Self-identified Hispanics were identified at 2 participating community hospitals close to the US-Mexico border. Patients hospitalized with a primary or secondary diagnosis of HF, living in the community (ie, not institutionalized)

Results

The sample was elderly (72 ± 11 years), 54% female, married (60%), and poorly educated (78.4% with less than a high school education). More than half (55%) of the patients were entirely unacculturated into US society (Table 1, Table 2). Eighteen (13.4%) patients had an event (eg, HF rehospitalization or death) in the first month. Two patients had an event (1 HF rehospitalization and 1 death) before the nurse case manager could contact them or their family.

No significant group differences were

Discussion

Telephone case management provided by bilingual/bicultural registered nurses decreased acute care resource use in the intervention group, at least initially, but the difference did not reach statistical significance. These results differ from our prior study of this intervention.¹⁴ Both studies took place in the same community, with most patients enrolled from the same hospital. Both studies weaned patients from the intervention at about the same rate over the 6 months of the study. There were

Acknowledgment

The authors gratefully acknowledge Sophia Jimenez for data collection, Belia Gastelum and Lisa Costello for providing the intervention, and the administrative support provided by Sharp HealthCare and Scripps Health in San Diego, CA.

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The findings of this review suggest that nurse-led electronic health interventions involving multiple patterns have an active influence on managing patients with chronic heart failure, including enhancing self-care, and medication adherence; increasing quality of life; reducing depression, anxiety, and improved patient satisfaction; increasing cardiac function, and reducing rehospitalization rate and hospitalization costs. Thus, it could be a promising alternative in the clinical settings.
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To discuss the effect of non-drug interventions on anxiety and depression in patients with heart failure (HF) through Bayesian network meta-analysis.
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A total of 23 papers were enrolled into this study. The results of Bayesian network meta-analysis showed that compared with the control group and the structured video conferencing support (SVCS) group, telephone case management (TCM) could effectively reduce the anxiety and depression of HF patients. The ranking results revealed that TCM may be the most effective intervention to lower the risk of depression in HF patients, followed by Tai Chi Chuan and Chi Kung training (TCC) and structured telephone support (STS).
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Citation Excerpt :
Participant characteristics varied among the studies. Two studies enrolled participants with a specific medical condition, including chronic pain28 and heart failure.32 One study screened for common chronic conditions, including cognitive impairment, urinary incontinence, falls, and functional impairment, in addition to depression, as part of the enrollment process.33
Comorbidity of psychiatric and medical illnesses among older adult populations is highly prevalent and associated with adverse outcomes. Care management is a common form of outpatient support for both psychiatric and medical conditions in which assessment, care planning, and care coordination are provided. Although care management is often remote and delivered by telephone, the evidence supporting this model of care is uncertain.
To perform a systematic review of the literature on remote care management programs for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness.
A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A multidatabase search was performed. Articles were included for review if they studied fully remote care management for older adult populations with elevated prevalence of depression or anxiety and chronic medical illness or poor physical health. A narrative synthesis was performed.
A total of 6 articles representing 6 unique studies met inclusion criteria. The 6 studies included 4 randomized controlled trials, 1 case-matched retrospective cohort study, and 1 pre-post analysis. Two studies focused on specific medical conditions. All interventions were entirely telephonic. Five of 6 studies involved an intervention that was 3 to 6 months in duration. Across the 6 studies, care management demonstrated mixed results in terms of impact on psychiatric outcomes and limited impact on medical outcomes. No studies demonstrated a statistically significant impact on health care utilization or cost.
Among older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness, remote care management may have favorable impact on psychiatric symptoms, but impact on physical health and health care utilization is uncertain. Future research should focus on identifying effective models and elements of remote care management for this population, with a particular focus on optimizing medical outcomes.
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: Funded by an outcomes research grant from the American Heart Association.

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Clinical InvestigationRandomized Controlled Trial of Telephone Case Management in Hispanics of Mexican Origin With Heart Failure

Abstract

Background

Methods and Results

Conclusion

Section snippets

Methods

Sample

Results

Discussion

Acknowledgment

Am Heart J

J Am Coll Cardio

Am Heart J

J Card Fail

J Card Fail

Am Heart J

J Chron Dis

J Am Coll Cardiol

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Eur J Heart Fail

Prevalence of depression in hospitalized patients with congestive heart failure

Psychosom Med

Comprehensive discharge planning with post discharge support for older patients with congestive heart failure: a meta-analysis

JAMA

Understanding racial and ethnic differences in health late in life: A research agenda

Knowledge and care of chronic illness in three ethnic minority groups

Fam Med

Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure

Circulation

Effect of a standardized nurse case management telephone intervention on resource use in chronic heart failure patients

Arch Intern Med

Clinical Investigation
Randomized Controlled Trial of Telephone Case Management in Hispanics of Mexican Origin With Heart Failure