Authors (including presenting author) :
Yu DSF (1), Leung CY (2), Ho CKH (3), Lau JCC(1), Li X (4), Chau PPH (1), Wong FKY (5), Lee MYM (6), Chan CMC (6)
Affiliation :
(1) School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, (2) Division of Cardiology, Department of Medicine, Tseung Kwan O Hospital, (3) Division of Cardiology, Department of Medicine, Tuen Mun Hospital, (4), Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, (5) School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, (6) Division of Cardiology, Department of Medicine Queen Elizabeth Hospital
Keyword 1: :
Heart failure
Keyword 2: :
transitional care
Keyword 3: :
patient-carer dyadic care approach
Keyword 4: :
digital healthcare
Keyword 5: :
hospital readmission
Keyword 6: :
cost-effectiveness
Introduction :
Global population aging has significantly increased healthcare costs worldwide, mainly for hospital and community health services. Heart failure (HF), as the endpoint of many cardiovascular diseases caused by inadequate myocardial pumping, has gained considerable attention. The World HF Epidemiology reports a lifetime risk of 1 in 5 for HF, with about 64.3 million cases globally—over 80% of which are over 60 years old. As a progressive organ failure, HF often deteriorates with recurrent episodes, making it the leading cause of hospitalization worldwide, with over 50% rehospitalization within six months. In Hong Kong, HF accounted for 23.1% of cardiovascular inpatient discharges and deaths, with 19,663 admissions, mainly due to decompensation causing pulmonary or systemic congestion and symptoms. Even though heart failure is usually managed with crucial input from carers, patient-carer dyadic approach has least applied in the transition care to optimize the post-discharge outcomes. With the evolvement of digital healthcare, it is timely to optimize the use of this platform to build a digital-dyadic care model to enhance the clinical, system and cost-effectiveness outcomes of the patients discharged with heart failure.
Objectives :
This double-blind randomized controlled trial was to compare the effects and cost-effectiveness of a theory-based dyadic empowerment-based heart failure management program (De-HF) with dyadic education on the patient-reported and carers’ health outcomes, self-care behaviors and clinical outcomes
Methodology :
From April 2023-Aug2024, this double-blind RCT randomized 236 care dyads [Mean age (SD): HF patients: 72.2(11.2); carer:57.7 (14.8)] to receive the 16-week De-HF program or a dyadic education program after hospital discharge, with outcome evaluated at baseline, 16th, 24th and 32nd week thereafter. The De-HF program actively engaged the patient-carer dyads in collaborative disease management through a dyadic assessment and subsequent goal-oriented interactive empowerment modules through virtual and tele platform. The dyadic education covered the same guideline-based topic as the De-HF program but without any input to promote collaborative care. Primary outcome was HRQL of the care dyads. Secondary outcomes include shared care and perceived control of the dyad and patients’ self-care, hospital readmission and AED admission. Data analysis by multilevel mixed-effect model, lagged-dependent actor-partner interdependence model (LD-APIM) and cost-effectiveness analysis were conducted.
Result & Outcome :
Among the 236 care dyads, the attrition rate due to withdrawal was 4.2% indicating high treatment acceptability. For the primary outcome (HRQL), as compared with the dyadic education, the De-HF program significantly increased the patients’ disease-specific HRQL [(T1: B=-7.89(95%CI=-11.31to-4.47); T2: B=-10.41(95%CI=-14.54 to -6.29); T3: B=-9.71(95%CI=-14.11 to -5.32)] throughout the 32-week evaluation. For dyadic HRQL, the LD-APIM also showed the De-HF program moderated significant actor effect among both patients and carer (p < 0.001), but not for partner effects. As for the secondary outcomes, De-HF program showed a moderate-to-large effects on self-care behaviours across the 32-week evaluation period [Cohen’s d: Self-care maintenance (0.461-0.550); Self-care management (0.631-0.792); Symptom perception (0.696-0.850)]. This may be related to the fact that the De-HF program has moderated a significant improvement in shared decision-making in the patients (actor effect: p=0.001; carer-to-patient partner effect: p=0.018) and perceived control among the carers (actor effects: p=0.015; patient-to-carer effect: p=0.025), under the positive influence from the partners. As for the clinical outcomes, the De-HF program has significantly delay the time to AED attendance [Hazard ratio (HR) (95%CI)=0.51(0.33–0.77)] and HF-related hospital readmission [HR(95%CI)=0.51(0.33-0.80)] and lower both undesirable incidents [IRR(95%CI): AED attendance=0.46(0.30-0.70); hospital readmission=0.46(0.29-0.73)]. The De-HF is also cost-effective, with the incremental cost-effectiveness ratio (ICER) as -HK$792 670 per QALY gained, –HK$23 224 to 47,633 per one minimally clinical significant improvement in self-care domains, -HK$95 457 per AED attendance avoided, and -HK$5 925 per hospital day avoided. De-HF is a highly effective, scalable solution that improves health outcomes and yields substantial cost savings, making it a promising model for advancing transitional heart-failure care.
