title: A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial.
abstract: BACKGROUND
  Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers' needs for information about the patient's status or how the caregiver can help.
  
  
  OBJECTIVE
  We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach.
  
  
  METHODS
  We identified 331 HF patients from Department of Veterans Affairs outpatient clinics. All patients identified a "CarePartner" outside their household. Patients randomized to "standard mHealth" (n=165) received 12 months of weekly interactive voice response (IVR) calls including questions about their health and self-management. Based on patients' responses, they received tailored self-management advice, and their clinical team received structured fax alerts regarding serious health concerns. Patients randomized to "mHealth+CP" (n=166) received an identical intervention, but with automated emails sent to their CarePartner after each IVR call, including feedback about the patient's status and suggestions for how the CarePartner could support disease care. Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate. Self-care and symptom data also were collected through the weekly IVR assessments.
  
  
  RESULTS
  Participants were on average 67.8 years of age, 99% were male (329/331), 77% where white (255/331), and 59% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8% more, 95% CI 1.2-16.5, P=.02) and 12 months (13.8% more, CI 3.7-23.8, P<.01), and 10.2% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls.
  
  
  CONCLUSIONS
  Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients' medication adherence and caregiver communication. mHealth+CP may also decrease patients' risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00555360; https://clinicaltrials.gov/ct2/show/NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B).
authors.affiliation: Center for Clinical Management Research and Center for Managing Chronic Disease, VA Ann Arbor Healthcare System and University of Michigan School of Public Health, Ann Arbor, MI, United States. jpiette@umich.edu.
authors.forename: John D
authors.identifier: http://orcid.org/0000-0002-7241-2798
authors.initials: JD
authors.lastname: Piette
authors.forename: Dana
authors.identifier: http://orcid.org/0000-0003-0149-8528
authors.initials: D
authors.lastname: Striplin
authors.forename: Nicolle
authors.identifier: http://orcid.org/0000-0003-3085-6419
authors.initials: N
authors.lastname: Marinec
authors.forename: Jenny
authors.identifier: http://orcid.org/0000-0002-9455-9037
authors.initials: J
authors.lastname: Chen
authors.forename: Ranak B
authors.identifier: http://orcid.org/0000-0003-4114-912X
authors.initials: RB
authors.lastname: Trivedi
authors.forename: David C
authors.identifier: http://orcid.org/0000-0002-2837-0797
authors.initials: DC
authors.lastname: Aron
authors.forename: Lawrence
authors.identifier: http://orcid.org/0000-0001-9481-9727
authors.initials: L
authors.lastname: Fisher
authors.forename: James E
authors.identifier: http://orcid.org/0000-0002-3795-9018
authors.initials: JE
authors.lastname: Aikens
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology* / Q000628:therapy; D004417:Dyspnea / Q000209:etiology; D034742:Electronic Mail; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000150:complications / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs; D015430:Weight Gain
keywords: disease management; heart failure; mobile health; self-management; telehealth