Quick phone calls show same effect as group classes for heart failure

An intensive program to teach self-management skills to heart failure patients didn't improve outcomes over a simple educational effort.

The trial included 902 patients from the Chicago area with mild to moderate heart failure who were randomized to one of two interventions. The education group received 18 educational tip sheets in the mail over the course of a year, with follow-up phone calls to check their comprehension of the information. The patients in the self-management group received the same tip sheets during group meetings in which they were also taught self-management skills to implement the advice. The study was published in the Sept. 22/29 Journal of the American Medical Association.

After two to three years of follow-up, there were no significant differences between the groups on any of the study's endpoints: death, heart failure hospitalization, all-cause hospitalization or quality of life. Previous smaller trials have also failed to find benefit in teaching self-management skills to heart failure patients, the study authors noted. However, it's still not entirely clear that these interventions are ineffective, the authors concluded. Subgroup analyses showed a trend suggesting that self-management counseling may be beneficial for low-income patients.

The 25% reduction in events expected by the study design may also have been excessively optimistic, the authors said. In that case, the trial may have been too small to find a treatment benefit. Another explanation is that the follow-up telephone calls received by the education group were more effective than expected, and that patients may have received self-management assistance during these contacts, an accompanying editorial speculated.

The intervention offered to the self-management group involved considerable cost and inconvenience to the patients, the editorialists said. They suggested that future efforts will likely involve electronic media rather than in-person meetings, and that medical professionals should continue to consider the possibilities of patients as participants in their own health care.