A randomized controlled trial to improve heart failure disparities: the Mālama Puʻuwai (caring for heart) Study

Abstract

Objective/Background: To conduct a randomized controlled trial to test the efficacy of a culturally tailored heart failure (HF) education program, to reduce HF hospital readmissions and/or cardiovascular disease death (HF outcomes) among Native Hawaiian and Other Pacific Islander (NHOPI) patients with HF. Methods: One hundred fifty HF patients aged ≥21 years, NHOPI race, and discharged to home were enrolled and randomized to the Mālama Puʻuwai Program (MPP) or the usual care (UC). The MPP group received a culturally tailored HF program, and the UC received similar standard HF education materials. Clinical and health behavior data were measured at baseline and 12 months. HF outcomes were monitored throughout the entire study period. Two-sample t-test, chi-square, and Cox proportional hazard modeling assessed the efficacy of intervention (MPP or UC) on HF outcomes using an intention-to-treat approach. A sensitivity post hoc analysis was performed on patients who completed the full intervention (n=127). Results: Overall, 69% were men, mean age 54.4±13.4 years, 62% were Native Hawaiian, and 24% reported methamphetamine use. More UC participants reported methamphetamine use (32% vs. 16%), hypertension (81% vs. 63%), but less myocardial infarction (27% vs. 48%). HF outcomes were higher in UC (31%) compared with MPP (19%) with higher risk for HF outcomes (hazard ratio [HR] 1.74; 95% CI: 0.89-3.40). Sensitivity post hoc analysis of intervention compliance revealed that UC was at significantly higher risk for HF outcomes than MPP (HR 2.83; 95% CI: 1.19-6.72). Conclusions: Culturally tailored HF programs have the potential to reduce HF outcomes among compliant minority patients with HF such as NHOPI.

Sharing the Patient Experience: A “Talk Story” Intervention for Heart Failure Management in Native Hawaiians

“…Topics were based on a patient education booklet initially developed through the Malama Pu'u Wai study to be culturally relevant to NH heart failure patients, which was in active clinical use at the pilot study site ( 16 ). The 11 patient education videos (fluids, medications, and what can damage the heart) were also developed from community and clinical experience and delivered by local cardiac care nurses at the pilot study site.…”

The characteristics of behaviour change interventions used among Pacific people: a systematic search and narrative synthesis

“…Fifteen studies were conducted in the USA -Hawai'i [43][44][45][46][47][48][49][50][51][52][53][54][55], California [56] and Arkansas [57], as well as its associated territories of American Samoa [58,59] and the Marshall Islands [60]. Seven were based in New Zealand [61][62][63][64][65][66][67] including one in Australia [68] and one in Samoa [69].…”

“…Nine studies [43, 44, 46-48, 50-52, 64] used a multiethnic cohort comparing Pacific (Native Hawaiians, Samoan, Tongan, Chuukese), Asian, Caucasian or other non-Pacific population groups. Seven studies focused on Pacific only cohorts, such as Native Hawaiian and other Pacific Islanders [45,53,55,56], Tongan and Samoan [62] and, Tongan, Niue and Cook Island [61] and Pacific Islanders (mixed) [67]. Two studies compared Pacific and Indigenous Māori [65,66].…”

“…Among the twenty-seven studies included in the review, eleven were randomised controlled trials [44,45,48,53,55,58,59,65,66,69] and thirteen were non randomised studies [43,46,47,49,51,52,56,57,60,62,64,67,68]. Other studies used a quasi-experimental design [63], a prospective uncontrolled cohort study [61] and a descriptive intervention study [50].…”

“…Ten studies increased awareness and targeted health behaviour change in people with diabetes [45, 48, 50, 57-60, 62, 64, 68] and eight studies targeted weight loss [43,44,46,47,51,54,63,67]. Others targeted chronic disease selfmanagement [52], and health-related behaviour [66], hypertension [53,65], smoking cessation [69], heart failure [55], renal disease [61], physical activity [56], and physical activity and nutrition combined [49]. Overall, diabetes was the most common long term condition focused in the studies.…”