title: Effects of Coping Skills Training on Quality of Life, Disease Biomarkers, and Clinical Outcomes in Patients With Heart Failure: A Randomized Clinical Trial.
abstract: BACKGROUND
  Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention.
  
  
  RESULTS
  This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040).
  
  
  CONCLUSIONS
  CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population.
  
  
  BACKGROUND
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.). sherw002@mc.duke.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherwood
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Gary G
authors.initials: GG
authors.lastname: Koch
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Benson M
authors.initials: BM
authors.lastname: Hoffman
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Lana L
authors.initials: LL
authors.lastname: Watkins
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Smith
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Kirkwood F
authors.initials: KF
authors.lastname: Adams
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Carla
authors.initials: C
authors.lastname: Sueta
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Kristy S
authors.initials: KS
authors.lastname: Johnson
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Jeanne
authors.initials: J
authors.lastname: Schwartz
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.S., J.A.B., B.M.H., L.L.W., P.J.S., C.M.O., J.G.R., K.S.J., J.S.); and University of North Carolina, Chapel Hill (G.G.K., K.F.A., C.S., P.P.C., A.L.H.).
authors.forename: Alan L
authors.initials: AL
authors.lastname: Hinderliter
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: adult; chronic disease; depression; hospitalization; quality of life