title: Pilot testing of a multicomponent home care intervention for older adults with heart failure: an academic clinical partnership.
abstract: BACKGROUND
  Heart failure (HF) has clinically significant psychological and physical consequences for older persons, and hospitalization for HF is frequent and costly to the Medicare program. As HF is the most common primary Medicare home care diagnosis, there is a critical need to develop home care services that improve heath-related outcomes for this population. The primary aim of this pilot study was to develop, implement, and test the initial feasibility and potential efficacy of the Home-Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. Observed outcomes were quality of life (QOL), depressive symptoms, and 90-day hospitalization.
  
  
  METHODS
  Twenty-four patients with a primary diagnosis of HF were assigned to the intervention (n = 12) or control group (n = 12) according to geographical location in a large multibranch Medicare-certified home health agency. Intervention group patients received 8 structured nurse education visits using evidence-based protocols designed in previous trials to teach HF self-management and to prevent/reduce depression, as well as a telemonitoring system. Control group patients received usual care and telemonitoring. Quality of life was assessed using the Minnesota Living With Heart Failure questionnaire. Depressive symptoms were assed using the Patient Health Questionnaire 9 at baseline and 90-day study end point.
  
  
  RESULTS
  Study protocols and instrumentation were found to be feasible and effective. Examination of enrollment data led to a reevaluation of eligibility criteria. Patients participating in the HEART intervention demonstrated significantly improved QOL (F = 8.99, P = .007) and significantly reduced depressive symptoms (F = 35.10, P = .001) in comparison to control group patients at the study end point. There was a trend toward lower hospital readmission rates in the intervention group (16% vs 25%), but this was not statistically significant.
  
  
  CONCLUSIONS
  This pilot study suggests that a full-scale trial of the HEART intervention is feasible.
authors.affiliation: University of Connecticut School of Nursing, Storrs, CT, USA. Colleen.Delaney@uconn.edu
authors.forename: Colleen
authors.initials: C
authors.lastname: Delaney
authors.forename: Beka
authors.initials: B
authors.lastname: Apostolidis
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001294:Attitude to Health; D003863:Depression / Q000453:epidemiology / Q000451:nursing; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000453:epidemiology / Q000451:nursing*; D006699:Home Care Services; D006801:Humans; D007318:Inservice Training; D008297:Male; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D010865:Pilot Projects; D011209:Power, Psychological; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires; D013686:Telemetry