Effects of Coping Skills Training on Quality of Life, Disease Biomarkers, and Clinical Outcomes in Patients with Heart Failure: A Randomized Clinical Trial

Andrew Sherwood, James A. Blumenthal, Gary G. Koch, Benson M. Hoffman, Lana L. Watkins, Patrick J. Smith, Christopher M. O'Connor, Kirkwood F. Adams, Joseph G. Rogers, Carla Sueta, Patricia P. Chang, Kristy S. Johnson, Jeanne Schwartz, Alan L. Hinderliter

Research output: Research - peer-reviewArticle

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Abstract

Background - Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention. Methods and Results - This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040). Conclusions - CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.

LanguageEnglish (US)
Article numbere003410
JournalCirculation: Heart Failure
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2017

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Psychological Adaptation
Randomized Controlled Trials
Heart Failure
Biomarkers
Quality of Life
Hospitalization
Heart Diseases
Confidence Intervals
Education
Vulnerable Populations
Self Care
Disease Management
Cardiomyopathies
Telephone
Chronic Disease
Outpatients
Clinical Trials
Depression
Walk Test
Surveys and Questionnaires

Keywords

  • adult
  • chronic disease
  • depression
  • hospitalization
  • quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effects of Coping Skills Training on Quality of Life, Disease Biomarkers, and Clinical Outcomes in Patients with Heart Failure : A Randomized Clinical Trial. / Sherwood, Andrew; Blumenthal, James A.; Koch, Gary G.; Hoffman, Benson M.; Watkins, Lana L.; Smith, Patrick J.; O'Connor, Christopher M.; Adams, Kirkwood F.; Rogers, Joseph G.; Sueta, Carla; Chang, Patricia P.; Johnson, Kristy S.; Schwartz, Jeanne; Hinderliter, Alan L.

In: Circulation: Heart Failure, Vol. 10, No. 1, e003410, 01.01.2017.

Research output: Research - peer-reviewArticle

Sherwood, Andrew ; Blumenthal, James A. ; Koch, Gary G. ; Hoffman, Benson M. ; Watkins, Lana L. ; Smith, Patrick J. ; O'Connor, Christopher M. ; Adams, Kirkwood F. ; Rogers, Joseph G. ; Sueta, Carla ; Chang, Patricia P. ; Johnson, Kristy S. ; Schwartz, Jeanne ; Hinderliter, Alan L./ Effects of Coping Skills Training on Quality of Life, Disease Biomarkers, and Clinical Outcomes in Patients with Heart Failure : A Randomized Clinical Trial. In: Circulation: Heart Failure. 2017 ; Vol. 10, No. 1.
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abstract = "Background - Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention. Methods and Results - This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040). Conclusions - CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.",
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AU - Koch,Gary G.

AU - Hoffman,Benson M.

AU - Watkins,Lana L.

AU - Smith,Patrick J.

AU - O'Connor,Christopher M.

AU - Adams,Kirkwood F.

AU - Rogers,Joseph G.

AU - Sueta,Carla

AU - Chang,Patricia P.

AU - Johnson,Kristy S.

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N2 - Background - Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention. Methods and Results - This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040). Conclusions - CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.

AB - Background - Heart failure (HF) is a chronic disease that compromises patients' quality of life (QoL). Interventions designed to reduce distress and improve disease self-management are needed. We evaluated the efficacy of a telephone-based coping skills training (CST) intervention. Methods and Results - This randomized clinical trial involved 180 HF outpatients with reduced ejection fraction. Participants ranged in age from 29 to 87 years (mean=58 years); 27% were women, and 47% were nonwhite. Participants were randomized to either a CST intervention or heart failure education, both delivered over 16 weeks. The primary outcomes were (1) postintervention effects on QoL and HF disease biomarkers (both with α=0.01), and (2) a composite measure of time to death or first hospitalization (with α=0.03) over a median follow-up period of 3 years. CST resulted in greater improvements in QoL compared with heart failure education (P<0.01), including the Kansas City Cardiomyopathy Questionnaire (P=0.009), depressive symptoms (P=0.027), and the 6-minute walk test (P=0.012). However, it did not differentially improve HF disease biomarkers or reduce risk of all-cause hospitalizations or death (hazard ratio=0.84 [95% confidence interval, 0.59-1.12]). Interestingly, exploratory analyses showed that participants randomized to CST experienced a reduction in the composite end point of worsening HF hospitalization or death during the 3-year follow-up period (hazard ratio=0.65 [95% confidence interval, 0.44-0.98]; P=0.040). Conclusions - CST improved QoL in patients with HF. Monitoring and improving QoL is emerging as an important aspect of the clinical management of HF that can reduce disease burden and may help improve clinical outcomes in this vulnerable patient population. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00873418.

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