An intervention for VA patients with congestive heart failure.
OBJECTIVE
To assess the effect of a telephone intervention to improve quality of life among patients with congestive heart failure (CHF).


METHODS
Prospective randomized study.


METHODS
Single-site recruitment of 458 patients using Veterans Health Administration care into a randomized controlled trial with a 1-year preintervention data collection period and a 1-year intervention and follow-up period. To compensate for imbalanced study groups, propensity scores were included in adjusted models of quality of life, satisfaction with care, inpatient utilization, survival, and costs of care.


RESULTS
Patients aged 45 to 95 years participated in the study; 22% were of Hispanic race/ethnicity, and 7% were African American. All but 5 were male, consistent with the older population among veterans. At baseline, 40% were in Goldman Specific Activity Scale class I, 42% were in class III, 6% were in class II or IV, and 12% were unclassified. Patients scored a mean (SD) of 14 (1.5) points below the norm on the physical component score. After the yearlong intervention, no differences in clinical outcomes were noted between the intervention group and the control group. The CHF-related costs were higher for the intervention group, as were overall costs that included the cost of the intervention. Intervention group patients reported better compliance with weight monitoring and exercise recommendations.


CONCLUSIONS
A risk-stratified intervention for patients with CHF resulted in potential behavioral improvements but no survival benefit. A high-cost high-intensity intervention may be required to improve survival for patients with CHF. Inclusion of the costs of interventions is recommended for future researchers.
VERDICT Research Center, Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229-4404, USA. laurel.copeland@va.gov
Laurel A
LA
Copeland
Gregory D
GD
Berg
Donna M
DM
Johnson
Richard L
RL
Bauer
D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000150:complications / Q000191:economics / Q000628:therapy; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care / Q000191:economics / Q000379:methods*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome; D014481:United States