(May 2018) Patients with chronic heart failure face related health problems,
such as depression and fatigue, that could be relieved by an expanded
model of care, according the study, “Improving Health Status for
Patients with Chronic Heart Failure,” published in JAMA Internal
David B. Bekelman, MD, MPH, associate professor
of medicine who practices at the Eastern Colorado Health Care System
for the U.S. Department of Veterans Affairs, and colleagues evaluated
314 patients, with half of them enrolled in a program that addressed
those related health status concerns.
Care to Alleviate Symptoms and Adjust to Illness intervention, also
called CASA, offered 157 of the patients a nurse and social worker in
addition to usual team of a primary care provider, cardiologist, and
palliative care physician addressing the patients’ needs. The CASA trial
is the first clinical trial of such a collaborate intervention in heart
failure and it included patients from VA, academic and safety-net
health systems in Colorado who received care between August 2012 and
The CASA intervention did not result in
significant changes in overall symptom distress, pain, shortness of
breath or number of hospitalization. The rate of death was similar – 10
of the patients in the CASA trial died, while 13 of those receiving the
typical standard of care died.
Still, the improvement in
cases of depression and fatigue are important results because they are
both difficult symptoms to treat in heart failure, Bekelman said.