Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics)

Abstract

BackgroundDisease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity.Methods/DesignClinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index ≥ 3, dependence in ≥ 2 activities of daily living, treatment with ≥ 5 drugs, active treatment for ≥ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations), diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care) and depression (knowledge of the disease, diagnosis and treatment). It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up.DiscussionThe physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study will provide direct evidence on the effect of a DMP in elderly patients with HF and high comorbidty, and will reduce the need to extrapolate the results of clinical trials in adults to elderly patients.Trial registration(ClinicalTrials.gov number, NCT01076465).

Health Literacy and Health Outcomes in Very Old Patients With Heart Failure

“…The study methods and main results have been published elsewhere. 12,13 Briefly, we recruited patients aged ! 75 years admitted with a primary diagnosis of HF to the geriatric acute-care unit of 6 hospitals in Spain.…”

“…The study sample was calculated to ensure sufficient statistical power to assess the effectiveness of a disease management program. 12 estudios inferiores a los primarios y el 71%, funció n sistó lica conservada. La AS se valoró con el cuestionario Short Assessment of Health Literacy for Spanish-speaking Adults; el conocimiento sobre la IC, con el cuestionario de DeWalt, y el autocuidado, con la European Heart Failure Self-Care Behaviour Scale.…”