Reducing Readmission for Frail Elderly Patients With Decompensated Heart Failure
- Conditions
- Heart FailureAcute Decompensated Heart FailureEmergenciesFragility
- Interventions
- Other: Control Group (Standard Care)Behavioral: Intervention Group
- Registration Number
- NCT03246035
- Lead Sponsor
- Jewish General Hospital
- Brief Summary
A randomized study designed to determine whether telephone based interventions can prevent return hospital visits for elderly and frail patients with acute symptoms of heart failure. Specifically, the intervention will improve patients ability to monitor and address self care of heart failure at home.
- Detailed Description
Acute decompensated heart failure (ADHF) is a common illness in Canadian emergency departments (ED). The frail subset of elderly patients with ADHF is challenging to treat, use a large proportion of available resources, and are at higher risk for complications, including readmission to hospital after discharge. The investigators believe that by improving access to follow-up, optimizing self-care, and addressing the various cognitive and physical limitations of frailty, it will be possible to improve quality of life and reduce readmission rates for frail patients with ADHF.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 60
- Patients who presented to the ED and who are being discharged with a primary or secondary diagnosis of ADHF
- Age ≥ 65
- Frailty, defined as a FRAIL score >=3/5 or Clinical Frailty Scale (CFS) score >=5/9
- Informed consent provided by the patient or proxy
- Significant dementia or active delirium
- Severe frailty, defined as a CFS score >=8/9
- Prohibitive language barrier
- Primary address outside of Quebec
- Patient deemed to be palliative or moribund by treating team
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Control Group (Standard Care) Control Group (Standard Care) The control group will receive outpatient follow-up, medication advice and lifestyle guidance as prescribed at discharge from the ED or hospital. Intervention Group Intervention Group The intervention will consist of contacting the patient 5 days post-discharge and arranging definitive outpatient follow-up and providing targeted medical and lifestyle advice based on deficient domains identified at baseline.
- Primary Outcome Measures
Name Time Method All-cause death, hospital readmission, or ED revisit 90 days
- Secondary Outcome Measures
Name Time Method Frailty Index 90 days Change in the Frailty Index from enrollment to follow-up
Informed consent validation (qualitative) 90 days Qualitative feedback from participants regarding the informed consent process
Self-Care Index 90 days Change in the Self-Care Heart Failure Index from enrollment to follow-up
Rate of return visits to any ER for any medical issue 30 days Number of times enrolled patient visits an emergency department for any medical issue, over the 90 day follow-up period.
Rate of admission to hospital at 90 days 90 days Number of times the patient needs to be admitted to hospital for any medical issue, over the 3 month follow-up period.
Heart Failure Symptom Scale 90 days Change in the 12 point Heart Failure Symptom Scale from enrollment to follow-up
Incidence of adverse effects from medication 90 days Number of patients who experience unexpected side effects from their heart failure medications
Recruitment rate 90 days The number of eligible of patients recruited into the study over a 3 month trial period
Attrition rate 90 days The number of patients enrolled the study who choose to leave the study before completing the follow-up
All-cause death, hospital readmission, or ED revisit 1 year
Trial Locations
- Locations (1)
Jewish General Hospital
🇨🇦Montréal, Quebec, Canada