A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial

Piette, John D; Striplin, Dana; Marinec, Nicolle; Chen, Jenny; Trivedi, Ranak B; Aron, David C; Fisher, Lawrence; Aikens, James E

doi:10.2196/jmir.4550

Cited by 131Mobile Health and mHealth ApplicationsHeart Failure Treatment and ManagementTelemedicine and Telehealth Implementation

A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial

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Piette, John D, Striplin, Dana, Marinec, Nicolle, Chen, Jenny, Trivedi, Ranak B, Aron, David C, Fisher, Lawrence, Aikens, James E·2015·Journal of Medical Internet Research

DOI 10.2196/jmir.4550PMC PMC4526929

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Abstract

BACKGROUND: Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers' needs for information about the patient's status or how the caregiver can help. OBJECTIVE: We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach. METHODS: We identified 331 HF patients from Department of Veterans Affairs outpatient clinics. All patients identified a "CarePartner" outside their household. Patients randomized to "standard mHealth" (n=165) received 12 months of weekly interactive voice response (IVR) calls including questions about their health and self-management. Based on patients' responses, they received tailored self-management advice, and their clinical team received structured fax alerts regarding serious health concerns. Patients randomized to "mHealth+CP" (n=166) received an identical intervention, but with automated emails sent to their CarePartner after each IVR call, including feedback about the patient's status and suggestions for how the CarePartner could support disease care. Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate. Self-care and symptom data also were collected through the weekly IVR assessments. RESULTS: Participants were on average 67.8 years of age, 99% were male (329/331), 77% where white (255/331), and 59% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8% more, 95% CI 1.2-16.5, P=.02) and 12 months (13.8% more, CI 3.7-23.8, P<.01), and 10.2% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls. CONCLUSIONS: Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients' medication adherence and caregiver communication. mHealth+CP may also decrease patients' risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys. TRIAL REGISTRATION: ClinicalTrials.gov NCT00555360; https://clinicaltrials.gov/ct2/show/NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B).

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Four trials failed to provide a full description of participants and losses to follow-up during their trials.
“Four trials failed to provide a full description of participants and losses to follow-up during their trials [24, 28, 29, 31].”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [31]
Piette et al. reported that the intervention group involving "CarePartners" connecting to a relative or friend living outside their home showed improvement in medication adherence (all P < 0.05).
“Piette et al. [31] in the US reported that the intervention group involving “CarePartners” connecting to a relative or friend living outside their home showed improvement in medication adherence and caregiver communication (all P < 0.05).”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [31]
Piette et al. reported that the intervention group involving "CarePartners" connecting to a relative or friend living outside their home showed improvement in caregiver communication (all P < 0.05).
“Piette et al. [31] in the US reported that the intervention group involving “CarePartners” connecting to a relative or friend living outside their home showed improvement in medication adherence and caregiver communication (all P < 0.05).”
From Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review (2018) · cites this paper as [31]

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A Randomized Trial of Mobile Health Support for Heart Failure Patients and Their Informal Caregivers
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Self-citation
Development and Evaluation of a Patient–Family Caregiver Dyad mHealth Intervention for Heart Failure Self-Care: Quasi-Experimental Study
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MECHANISMS OF CHANGE IN A CAREPARTNER MOBILE HEALTH INTERVENTION FOR VETERANS WITH HEART FAILURE
TRIVEDI, R. B., Scott, S., Bouldin, E. D., Aikens, J. E., & Piette, J. D. (2017) · Innovation in Aging · doi:10.1093/geroni/igx004.1172
Self-citation
Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial
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The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature
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Authors: Piette, J. D., Striplin, D., Marinec, N., Chen, J., Trivedi, R. B., Aron, D. C., Fisher, L., & Aikens, J. E.
Affiliations: University of Michigan (US)
VA Palo Alto Health Care System (US)
Louis Stokes Cleveland VA Medical Center (US)
University of California, San Francisco (US)
Corresponding author: Piette, John D
ORCID: Piette, John D
Striplin, Dana
Marinec, Nicolle
Chen, Jenny
Trivedi, Ranak B
Aron, David C
Fisher, Lawrence
Aikens, James E
Venue: Journal of Medical Internet Research
Publisher: JMIR Publications Inc.
Published: 2015-06-10
Volume: 17
Issue: 6
Pages: e142
ISSN: 1438-8871 (ISSN-L)
DOI: 10.2196/jmir.4550
PMC: PMC4526929
OpenAlex: W1907187185
Cited by: 131
References: 64
Citations by year: 2026: 3 · 2025: 13 · 2024: 14 · 2023: 10 · 2022: 13 · 2021: 8 · 2020: 17 · 2019: 13 · 2018: 13 · 2017: 12 · 2016: 12 · 2015: 3
FWCI: 22.66
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Journal of Medical Internet Research (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Funders: U.S. Department of Veterans Affairs (IIR 07-185)
Health Services Research and Development
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
Topics: Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords: heart failure, mobile health, informal caregivers, interactive voice response, medication adherence, self-care, caregiver involvement, caregiver-patient communication, quality of life, veterans, symptom monitoring
MeSH terms: Aged, Depression, Dyspnea, Female, Health Status, Heart Failure, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Self Care, Telephone, United States, United States Department of Veterans Affairs, Weight Gain, Caregivers, Telemedicine, Electronic Mail, Medication Adherence

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A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial

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