Cost Effectiveness and Quality of Life in Heart Failure Patients With Diabetes
| Status: | Completed |
|---|---|
| Conditions: | Cardiology, Diabetes |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology |
| Healthy: | No |
| Age Range: | 21 - 80 |
| Updated: | 11/30/-0001 |
| Start Date: | September 2009 |
| End Date: | January 2013 |
| Contact: | Maureen O Lobb, RN, PhD |
| Email: | omauree@emory.edu |
| Phone: | 404-321-6111 |
The purposes of this study are:
1. to develop and test an integrated self care intervention for Heart Failure (HF)patients
with Diabetes (DM) for its effects on patient outcomes including health related quality
of life (HRQOL), physical function and health resource utilization.
2. to assess the costs and cost effectiveness of the intervention.
The intervention is designed to go beyond usual care of providing separate Heart Failure
(HF) and Diabetes (DM) patient education by educating HF-DM patients on integrated self care
and self management related to a HF-DM diet, HF-DM medication-taking behaviors, physical
activity, and HF-DM symptom monitoring and management. An integrated self care intervention
will compare HF-DM patients who receive the intervention with those who receive usual
care-attention control for effects on patient outcomes,self care process measures, and
health care utilization. If effective, the intervention will lead to improved self care,
improved quality of life, and reduced health care resource use and costs. This study will
facilitate greater understanding of self care within the context of two chronic illnesses
and will lead directly to improved clinical practice and future research on comorbid self
care in Heart Failure.
The investigators hypothesize that participants receiving the Heart Failure and Diabetes
(HF-DM) self-care intervention will report greater Health Related Quality of Life (HRQOL) on
the Minnesota Living with HF Questionnaire (MLHFQ), the Audit of Diabetes-dependent Quality
of Life (ADDQoL), and the EuroQol (EQ5D) than the Usual Care (UC-AC) group at 6 months when
controlling for age, gender, and NYHA Class.
Secondly, that participants receiving the Heart Failure and Diabetes (HF-DM) self-care
intervention will demonstrate improved physical function indicators (BNP levels, HgA1c, and
6MWT) at 6 months over the UC-AC group when controlling for age, gender, BMI, and NYHA Class
and comorbid conditions.
Thirdly, that participants receiving the Heart Failure and Diabetes (HF-DM) self-care
intervention will exhibit greater improvement in: HF knowledge and DM knowledge than UC-AC
at 6 months. Participants receiving the integrated HF-DM self-care intervention will report
greater improvements in HF self-efficacy and DM self-efficacy over UC-AC at 6 months. HF-DM
patients randomized to the integrated self-care intervention will exhibit greater
improvements in overall HF and DM self-care behaviors and HF-DM diet and physical activity
over UC-AC at 6 months.
Lastly, that HF-DM patients who receive the integrated self-care intervention will exhibit
less health resource use and associated costs(direct health care costs of provider visits,
hospitalizations, ED visits, length of stay, and direct non-health care costs associated
with the HRU and intervention) over the 6 months than those who receive UC-AC controlling
for comorbidity and insurance status.
Inclusion Criteria:
- hospital admission with a diagnosis of Heart Failure (HF) with Left Ventricular
Systolic Dysfunction (LVSD) or diastolic dysfunction and concomitant Diabetes (DM)
type II
- planned discharge from hospital to home setting
- NYHA Class II-IV
- On optimal HF regimen of care including ACE-Inhibitors or ARBs beta blocking agents,
and diuretics if indicated by patient fluid status
- ambulatory
- able to read and write English
- acceptable cognitive screening test
Exclusion Criteria:
- planned discharge to long term acute care
- presence of an insulin pump
- active foot ulcer
- presence of hemodynamically significant angina pectoris
- renal failure with hemodialysis
- planned cardiac surgery
- impaired cognition due to neurological comorbidity
- psychiatric diagnosis
- uncorrected visual or hearing problem
- uncorrected hearing or vision problems
- moderately severe depressive symptoms
- UNOS/ A status or ventricular assist device
- lack of telephone access
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