Improving Health Status for People with Heart Failure

(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 Medicine.

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.

The Collaborative 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 April 2015.

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.