Reducing Readmission for Frail Elderly Patients With Decompensated Heart Failure

Jewish General Hospital60 enrolled

Overview

A randomized study designed to determine whether telephone based interventions can prevent return hospital visits for elderly and frail patients with acute symptoms of heart failure. Specifically, the intervention will improve patients ability to monitor and address self care of heart failure at home.

Acute decompensated heart failure (ADHF) is a common illness in Canadian emergency departments (ED). The frail subset of elderly patients with ADHF is challenging to treat, use a large proportion of available resources, and are at higher risk for complications, including readmission to hospital after discharge. The investigators believe that by improving access to follow-up, optimizing self-care, and addressing the various cognitive and physical limitations of frailty, it will be possible to improve quality of life and reduce readmission rates for frail patients with ADHF.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Heart Failure Acute Decompensated Heart Failure Fragility Emergencies

Interventions

Intervention GroupBEHAVIORAL

For the intervention arm, a specialized heart failure nurse practitioner will contact the patient or their primary caregiver by telephone within 5 days post-discharge and send them an education packet by mail. During the telephone call, the nurse will (1) confirm the patient's scheduled follow-up appointment in cardiology, (2) provide recommendations for heart failure self-care behaviors that were found to be deficient at baseline. Patients will then be referred to a Geriatrics Assessment Team, who will provide individualized recommendations for frailty domains that were found to be deficient at baseline. The technique used to provide educational recommendations will be motivational interviewing.

Control Group (Standard Care)OTHER

For patients randomized to the Control Group (Standard Care), they will receive their follow-up visits, medications, diet and physical activity advice as they normally would. This is the care they would receive even if they were not enrolled in the study

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients who presented to the ED and who are being discharged with a primary or secondary diagnosis of ADHF * Age ≥ 65 * Frailty, defined as a FRAIL score \>=3/5 or Clinical Frailty Scale (CFS) score \>=5/9 * Informed consent provided by the patient or proxy Exclusion Criteria: * Significant dementia or active delirium * Severe frailty, defined as a CFS score \>=8/9 * Prohibitive language barrier * Primary address outside of Quebec * Patient deemed to be palliative or moribund by treating team

Locations (1)

Jewish General Hospital

Montreal, Quebec, Canada

Outcomes

Primary Outcomes

All-cause death, hospital readmission, or ED revisit

Time frame: 90 days

Secondary Outcomes

Rate of return visits to any ER for any medical issue

Number of times enrolled patient visits an emergency department for any medical issue, over the 90 day follow-up period.

Time frame: 30 days

Rate of admission to hospital at 90 days

Number of times the patient needs to be admitted to hospital for any medical issue, over the 3 month follow-up period.

Time frame: 90 days

Incidence of adverse effects from medication

Number of patients who experience unexpected side effects from their heart failure medications

Time frame: 90 days

Self-Care Index

Change in the Self-Care Heart Failure Index from enrollment to follow-up

Time frame: 90 days

Heart Failure Symptom Scale

Change in the 12 point Heart Failure Symptom Scale from enrollment to follow-up

Time frame: 90 days

Frailty Index

Change in the Frailty Index from enrollment to follow-up

Time frame: 90 days

Recruitment rate

The number of eligible of patients recruited into the study over a 3 month trial period

Time frame: 90 days

Data from ClinicalTrials.gov

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