title: The Heart Failure Adherence and Retention Trial (HART): design and rationale.
abstract: BACKGROUND
  Heart failure (HF) is increasing in prevalence and is associated with prolonged morbidity, repeat hospitalizations, and high costs. Drug therapies and lifestyle changes can reduce hospitalizations, but nonadherence is high, ranging from 30% to 80%. There is an urgent need to identify cost-effective ways to improve adherence and reduce hospitalizations.
  
  
  METHODS
  The Heart Failure Adherence and Retention Trial (HART) evaluated the benefit of patient self-management (SM) skills training in combination with HF education, over HF education alone, on the composite end points of death/HF hospitalizations and death/all-cause hospitalizations in patients with mild to moderate systolic or diastolic dysfunction. Secondary end points included progression of HF, quality of life, adherence to drug and lifestyle regimens, and psychosocial function. The HART cohort was composed of 902 patients including 47% women, 40% minorities, and 23% with diastolic dysfunction. After a baseline examination, patients were randomized to SM or education control, received 18 treatment contacts over 1 year, annual follow-ups, and 3-month phone calls to assess primary end points. Self-management treatment was conducted in small groups and aimed to activate the patient to implement HF education through training in problem-solving and 5 SM skills. The education control received HF education in the mail followed by a phone call to check comprehension.
  
  
  CONCLUSIONS
  The significance of HART lies in its ability to determine the clinical value of activating the patient to collaborate in his or her care. Support for the trial hypotheses would encourage interdisciplinary HF treatment, drawing on an evidence base not only from medicine but also from behavioral medicine.
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA. lpowell@rush.edu
authors.forename: Lynda H
authors.initials: LH
authors.lastname: Powell
authors.forename: James E
authors.initials: JE
authors.lastname: Calvin
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Mendes de Leon
authors.forename: Dejuran
authors.initials: D
authors.lastname: Richardson
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Flynn
authors.forename: Cheryl S
authors.initials: CS
authors.lastname: Rucker-Whitaker
authors.forename: Imke
authors.initials: I
authors.lastname: Janssen
authors.forename: Glenda
authors.initials: G
authors.lastname: Kravitz
authors.forename: Claudia
authors.initials: C
authors.lastname: Eaton