Colo. – Patients with chronic heart failure face related
problems, such as depression and fatigue, that could be relieved by an expanded
model of care, according to a recently published study led by a researcher from
the University of Colorado School of Medicine.
study, “Effect of a Collaborative Care
Intervention vs Usual Care on Health Status of Patients With Chronic Heart
Failure: The CASA Randomized Clinical Trial,” published in the current issue of
the journal JAMA Internal Medicine, found benefit to some aspects of patients’
quality of life when conventional cardiac therapy is supplemented with a nurse
and a social worker who collaborate with a team to address patients’ symptom
and psychosocial needs.
of the 5.8 million Americans with heart failure live with bothersome symptoms,
reduced function and poor quality of life” said David B. Bekelman, MD, MPH, the
study primary author. “Improving their care is important because many people
with heart failure live with these challenges for years.”
an associate professor of medicine who practices at the Eastern Colorado Health
Care System for the U.S. Department of Veterans Affairs, and his colleagues
evaluated 314 patients, with half of them enrolled in a program that addressed
those quality of life concerns.
Collaborative Care to Alleviate Symptoms and Adjust to Illness intervention,
also called CASA, offered 157 patients a nurse and social worker who
collaborated with a primary care provider, cardiologist, and palliative care
physician to address the patients’ needs. The CASA trial is the first clinical
trial of such a collaborative intervention in heart failure and it included
patients receiving care from VA, academic and safety-net health systems in
Colorado between August 2012 and April 2016. Patients enrolled in the study
were evaluated for a one-year period. The typical CASA intervention was three
to four months.
CASA intervention significantly improved patients’ depression and fatigue but
did not result in significant changes in heart failure-specific health status,
pain, shortness of breath, or number of hospitalizations. The number who died
during the study was similar – 10 of the patients in the CASA intervention
died, while 13 of those receiving the typical standard of care died.
improvements in depression and fatigue are important results because they are
both common, burdensome, and difficult to treat in heart failure, Bekelman
said. Very few other studies have found treatments for these symptoms in
patients with heart failure. Furthermore, the improvement in depression lasted
the whole duration of the patient’s 12-month study period, months after the
CASA intervention ended.
discussed several next steps in the research, including studying the
intervention in a higher-risk or more ill population, and using health
technology, such as videoconference, to extend the reach of the CASA
addition to Bekelman, authors of the study included faculty from the CU School
of Medicine (Larry A. Allen, MD, MHS; Connor F. McBryde, MD; Brack Hattler, MD;
and Edward P. Havranek, MD), the Colorado School of Public Health (Diane L.
Fairclough, DrPH), the University of Iowa Carver College of Medicine (Carolyn
Turvey, PhD) and the CU College of Nursing (Paula M. Meek, RN, PhD).
study was supported by funding from the National Institute of Nursing Research,
the Colorado Clinical and Translational Sciences Institute, and the VA’s Health
Services Research and Development Service.