Randomized controlled effectiveness trial of reciprocal peer support in heart failure

Abstract

Background: Although disease management programs for patients hospitalized with heart failure (HF) are effective, they are, however, often resource intensive, limiting their uptake. Peer support programs have led to improved outcomes among patients with other chronic conditions and may result in similar improvements for patients with HF.

Methods and results: In this randomized controlled trial, reciprocal peer support (RPS) arm patients participated in a HF nurse practitioner-led goal setting group session, received brief training in peer communication skills, and were paired with another participant in their cohort with whom they were encouraged to talk weekly using a telephone platform. Participants were also encouraged to attend 3 nurse practitioner-facilitated peer support group sessions. Patients in the nurse care management arm attended a nurse practitioner-led session to address their HF care questions and receive HF educational materials and information on how to access care management services. The median age of the patients was 69 years; 51% were female and 26% were racial/ethnic minorities. Only 55% of RPS patients participated in peer calls or group sessions. In intention-to-treat analyses, the RPS and nurse care management groups did not differ in time-to-first all-cause rehospitalization or death or in mean numbers of rehospitalizations or deaths. There were no differences in improvements in 6-month measures of HF-specific quality of life or social support. Conclusions- Among patients recently hospitalized for HF, more than half of RPS participants had no or minimal engagement with the RPS program, and the program did not improve outcomes compared with usual HF nurse care management.

Clinical trial registration: URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00508508.

Figures

Figure 1. CONSORT 2010 Flow Diagram

*Survey outcomes: Social support, Depression, QOL, Self Efficacy, and Treatment Satisfication **Primary outcomes: Death and Hospitalization. Data censored after date of last contract for 10 subjects lost to follow-up.

Figure 2. Mean Frequency and Mean Duration of Calls by Month for the 75 participants who had at least one telephone call

*75/124 (60%) had at least one call

Figure 3. Kaplan-Meier Curves - Time to Hospitalization or Death (in days)