Automated E-Counseling for Chronic Heart Failure: CHF-CePPORT Trial.

Robert P Nolan, Heather J Ross, Michael E Farkouh, Ella Huszti, Sammy Chan, Mustafa Toma, Bianca D'Antono, Michel White, Scott Thomas, Susan I Barr, Sylvie Perreault, Michael McDonald, Shelley Zieroth, Debra Isaac, Andreas Wielgosz, Lisa Marie Mielniczuk

Journal: Circulation. Heart failure 2021;14(1):e007073

PMID: 33464959

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Abstract

BACKGROUND

International task force statements advocate telehealth programs to promote health-related quality of life for patients with chronic heart failure (CHF). To that end, we evaluated the efficacy and usability of an automated e-counseling program.

METHODS

This Canadian multi-site double-blind randomized trial assessed whether usual care plus either internet-based e-counseling (motivational and cognitive-behavioral tools for CHF self-care) or e-based conventional CHF self-care education (e-UC) improved 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS). Secondary outcomes included program engagement (total logon weeks, logons, and logon hours), total CHF self-care behaviors, diet (fruit and vegetable servings), 6-minute walk test, and 4-day step count. The association between program engagement and health-related quality of life was assessed using KCCQ-OS tertiles.

RESULTS

We enrolled 231 patients, median age =59.5 years, 22% female, and elevated median KCCQ-OS=83.0 (interquartile range, 68-93). KCCQ-OS increase ≥5 points was not more prevalent for e-counseling, n=29 (29.6%) versus e-UC, n=32 (34.0%), =0.51. E-Counseling versus e-UC increased total logon weeks (=0.02), logon hours (=0.001), and logons (<0.001). Only e-counseling showed a positive association between 12-month KCCQ-OS tertile and logon weeks (=0.04) and logon hours (=0.004). E-Counseling increased CHF self-care behavior and diet but not 6-minute walk test or 4-day step count.

CONCLUSIONS

The primary KCCQ-OS end point was negative for this trial. Only e-counseling showed a positive association between program engagement and 12-month KCCQ-OS tertile, and it improved CHF self-care behavior and diet. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01864369.

Address: Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Center (R.P.N.), University Health Network, Toronto, ON, Canada.; Faculty of Medicine (R.P.N., H.J.R., M.E.F., M.M.), University of Toronto, ON, Canada.; Division of Cardiology, Peter Munk Cardiac Center (H.J.R., M.E.F., M.M.), University Health Network, Toronto, ON, Canada.; Faculty of Medicine (R.P.N., H.J.R., M.E.F., M.M.), University of Toronto, ON, Canada.; Theta Institute (E.H.), University Health Network, Toronto, ON, Canada.; Faculty of Medicine (S.C., M.T.), University of British Columbia, Vancouver, Canada.; Department of Cardiology, St Paul's Hospital, Vancouver, BC, Canada (S.C., M.T.).; Centre de Recherche, Institut de Cardiologie de Montréal, QC, Canada (B.D., M.W.).; Département de Psychologie (B.D.).; Université de Montréal, QC, Canada (B.D.).; Centre de Recherche, Institut de Cardiologie de Montréal, QC, Canada (B.D., M.W.).; Faculty of Kinesiology and Physical Education (S.T.), University of Toronto, ON, Canada.; Department of Food, Nutrition, and Health (S.I.B.), University of British Columbia, Vancouver, Canada.; Faculté de Pharmacie (S.P.).; Faculty of Medicine, University of Manitoba, Winnipeg, Canada (S.Z.).; Cardiac Transplant Clinic, Libin Cardiovascular Institute of Alberta, Calgary, Canada (D.I.).; Department of Medicine, University of Ottawa, Canada (A.W.).; University of Ottawa Heart Institute, ON, Canada (L.M.M.).

DOI: 10.1161/CIRCHEARTFAILURE.120.007073

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MeSH Terms: Aged, Cognitive Behavioral Therapy, Diet, Distance Counseling, Double-Blind Method, Female, Heart Failure, Humans, Internet-Based Intervention, Male, Middle Aged, Motivation, Motivational Interviewing, Patient Reported Outcome Measures, Self Care, Surveys and Questionnaires, Treatment Outcome, Walk Test