A randomized trial of mobile health support for heart failure patients and their informal caregivers: impacts on caregiver-reported outcomes

Abstract

Background: Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers' efforts.

Objectives: To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management.

Research design: Randomized comparative effectiveness trial.

Subjects: A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system. All patients participated with a "CarePartner" or informal caregiver outside their household.

Intervention: Patients randomized to "standard mHealth" received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. "mobile health+CarePartner" (mHealth+CP) patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners.

Measures: At baseline, 6, and 12 months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support.

Results: mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months (both P≤0.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (P≤0.03 for interactions between arm and baseline strain/depression at both endpoints). Although most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all P<0.05). mHealth+CP CarePartners reported more frequently attending patients' medical visits at 6 months (P=0.049) and greater involvement in medication adherence at both endpoints (both P≤0.032).

Conclusions: When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners' engagement in self-care.

Trial registration: ClinicalTrials.gov NCT00555360.

Figures

Figure 1

CONSORT Diagram for participants in the trial

Figure 2. Comparison of changes in caregiving burden between baseline and six-months (left panel), and baseline and twelve months (right panel)

Caregiving burden was measured using the Caregiver Strain Index. Standard mHealth=patients randomized to IVR monitoring and self-care support with clinician alerts. mHealth+CP=patients randomized to the same intervention + weekly feedback to patients’ CarePartners.

Figure 3. Comparison of changes in depressive symptoms between baseline and six months (left panel), and baseline and twelve months (right panel)

Depressive symptoms were measured using the 10-item version of the CES-D. Standard mHealth=patients randomized to IVR monitoring and self-care support with clinician alerts. mHealth+CP=patients randomized to the same intervention + weekly feedback to patients’ CarePartners.