EPIC-HF and MyROAD Trials Explore HF Patient Tools
Nearly half of heart failure (HF) patients who received a patient engagement and education tool prior to a cardiology clinic visit had a positive change in their medication therapy, according to results of the EPIC-HF trial presented Nov. 17 during AHA 2020 and simultaneously published in Circulation. A separate study also presented during AHA 2020 found that listening to audio messages about self-care at home may improve clinical outcomes for HF patients.
In the EPIC-HF trial, Larry A. Allen, MD, MHS, FACC, et al., looked at 290 patients with heart failure with reduced ejection fraction (HFrEF) who were randomized to receive usual care vs. additional patient engagement and education tools (a three-minute video and a one-page medication checklist) delivered electronically one week, three days and 24 hours prior to a visit at a cardiology clinic. The median age was 65 years, 29% were female, and the median left ventricular ejection fraction was 32%.
Results showed that 30 days after the cardiology clinic visit, nearly half (49%) of the patient tools group had an initiation or intensification of their guideline-directed medical therapy vs. 29.7% in the usual care group. In addition, most changes were increases in the doses of generic HFrEF medications already prescribed, not new medications.
"This approach validates and promotes a culture of collaboration between patients and their doctors and leads to more productive clinic visits with optimized medication prescribing, which can ultimately improve patient outcomes," said Allen.
Meanwhile, a separate study by Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, looked at about 1,000 patients (average age 72.8 years, 58.7% male) who were hospitalized with HF at four sites in Northeast Ohio. Upon discharge, patients were randomized to receive either usual care or MyROAD – a re-playable audio card containing information about diet, physical activity, medication and self-monitoring behaviors for HF patients who have been discharged from the hospital. The researchers followed up at 30, 45, 90 and 180 days after hospital discharge.
Results showed that the MyROAD group had a 27% decrease in the odds of visiting the emergency department for any cause 30 days after initial hospital discharge and a 29% decrease at 45 days, however the researchers note that the difference was not statistically significant. In addition, the MyROAD group was 40% less likely to need a heart-assist device, receive a heart transplant or die from any cause at three months after discharge.
Patients in the MyROAD group were also nearly 50% less likely to die from heart failure at 90-days after discharge. All causes of death dropped by more than 40% among the MyROAD group vs. the usual care group.
"These results may spur innovative methods of enhancing discharge information and early home care," said Albert. "More research is needed to learn how we can optimize care to prevent post-discharge health care utilization."
Keywords: AHA Annual Scientific Sessions, AHA20, Heart Failure, Stroke Volume
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