Telephone support to rural and remote patients with heart failure: the Chronic Heart Failure Assessment by Telephone (CHAT) study.
BACKGROUND
Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses.


METHODS
Patients with a general practice (GP) diagnosis of HF were randomized to usual care (UC) or UC and telephone support intervention (UC+I) using a cluster design involving 143 GPs throughout Australia. Patients were followed up for 12 months. The primary endpoint was the Packer clinical composite score. Secondary endpoints included hospitalization for any cause, death or hospitalization, as well as HF hospitalization.


RESULTS
Four hundred and five patients were randomized to CHAT. Patients were well matched at baseline for key demographic variables. The primary endpoint of the Packer score was not different between the two groups (P = 0.98), although more patients improved with UC+I. There were fewer patients hospitalized for any cause (74 vs. 114, adjusted HR 0.67 [95% CI 0.50-0.89], P = 0.006) and who died or were hospitalized (89 vs. 124, adjusted HR 0.70 [95% CI 0.53-0.92], P = 0.011), in the UC+I vs. UC group. HF hospitalizations were reduced with UC+I (23 vs. 35, adjusted HR 0.81 [95% CI 0.44-1.38]), although this was not significant (P = 0.43). There were 16 deaths in the UC group and 17 in the UC+I group (P = 0.43).


CONCLUSIONS
Although no difference was observed in the primary endpoint of CHAT (Packer composite score), UC+I significantly reduced the number of HF patients hospitalized among a rural and remote cohort. These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients.
Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Vic., Australia. henry.krum@med.monash.edu.au
Henry
H
Krum
Andrew
A
Forbes
Julie
J
Yallop
Andrea
A
Driscoll
Jo
J
Croucher
Bianca
B
Chan
Robyn
R
Clark
Patricia
P
Davidson
Luan
L
Huynh
Edward K
EK
Kasper
David
D
Hunt
Helen
H
Egan
Simon
S
Stewart
Leon
L
Piterman
Andrew
A
Tonkin
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D019035:Rural Health Services; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome