1 A Randomized Controlled Effectiveness Trial of Reciprocal Peer Support in Heart Failure Heisler et al: Reciprocal Peer Support in Heart Failure Michele Heisler, MD, MPA 1,2,3 ; Lakshmi Halasyamani, MD 4 ; Mark E. Cowen, MD, SM 4; Matthew D. Davis, MD, MAPP 1,5 ; Ken Resnicow, Ph.D 3 ; Robert L. Strawderman, ScD 6 ; Hwajung Choi, PhD 1 ; Rebecca Mase, MSW 1,2 ; John D. Piette, PhD 1,2 1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI 2 Center for Clinical Management Research, Ann Arbor Veterans’ Affairs (VA) Healthcare System 3 Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 4 Saint Joseph Mercy Health System, Ann Arbor, MI. 5 Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 6 Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY Correspondence to: Michele Heisler, MD, MPA PO Box 130170, 11H Ann Arbor, MI 48113 Phone: (734) 845-3504 Fax: (734) 222-7503 [email protected]DOI: 10.1161/CIRCHEARTFAILURE.112.000147 Journal Subject Codes: 110, 117 by guest on June 1, 2018 http://circheartfailure.ahajournals.org/ Downloaded from
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A Randomized Controlled Effectiveness Trial of Reciprocal Peer Support in Heart Failure
Heisler et al: Reciprocal Peer Support in Heart Failure
Michele Heisler, MD, MPA1,2,3; Lakshmi Halasyamani, MD4; Mark E. Cowen, MD, SM4;
Matthew D. Davis, MD, MAPP1,5; Ken Resnicow, Ph.D3; Robert L. Strawderman, ScD6;
Hwajung Choi, PhD1; Rebecca Mase, MSW1,2; John D. Piette, PhD1,2
1Department of Internal Medicine, University of Michigan, Ann Arbor, MI 2Center for Clinical Management Research, Ann Arbor Veterans’ Affairs (VA) Healthcare System 3Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 4Saint Joseph Mercy Health System, Ann Arbor, MI. 5Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 6 Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
Correspondence to: Michele Heisler, MD, MPA PO Box 130170, 11H Ann Arbor, MI 48113 Phone: (734) 845-3504 Fax: (734) 222-7503 [email protected] DOI: 10.1161/CIRCHEARTFAILURE.112.000147 Journal Subject Codes: 110, 117
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We thank the very dedicated HF nurse practitioners who participated in this intervention as part
of their work assignments.
Sources of Funding
This research was supported by NHLBI grant [R01 HL085420] and Michigan Institute for
Clinical and Health Research (NIH #UL1RR024986). John Piette is a VA Research Career
Scientist.
Disclosures
The authors have no conflict of interest or financial disclosures. The funding sources had no role
in study design, implementation, analyses, or reporting.
References
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mean(SD) Age in years 70.4 (11.5) 67.9 (12.6) .15 69.1(12.1%) Female gender 70 (51.9%) 68 (51.9%) .99 137 (51%) Race or Ethnicity .53
White 104 (77.0%) 93 (71.0%) 197 (74.1%) Black 26 (19.3%) 32 (24.4%) 58 (21.8%) Other 5 (3.7%) 6 (4.6%) 11 (4.1%)
Education .43 HS graduate or less 58 (43%) 58 (44%) 115 (43%) Some college, technical, or vocational 45 (34%) 50 (38%) 95 (36%) 4 year college or more 32 (24%) 23 (18%) 55 (21%)
Annual Income .27 ≤ $19,000 33 (27%) 27 (24%) 60 (26%) $20,000 to $39,000 49 (40%) 56 (50%) 105 (45%) $40,000 or more 41 (33%) 29 (26%) 70 (30%)
Hospitalization in the past year .25 none 19 (14.1%) 20 (15.3%) 39 (14.7%) 1 58 (43.0%) 70 (53.4%) 128 (48.1%) 2 40 (29.6%) 27 (20.6%) 67 (25.2%) 3+ 18 (13.3%) 14 (10.7%) 32 (12.0%)
Health History History of atrial fibrillation 50 (37%) 47 (35.9%) .84 97 (36.5%)
History of myocardial infarction 14 (10.4%) 12 (9.2%) .74 26 (9.8%) History of chronic obstructive pulmonary disease
41 (30.4%) 38 (29.0%) .81 79 (29.7%)
History of diabetes 57 (42.2%) 55 (42.0%) .97 112 (42.1%) History of hypertension 97 (71.9%) 85 (64.9%) .22 182 (68.4%) History of respiratory failure 16 (11.9%) 11 (8.4%) .35 27 (10.2%) History of valvular heart disease 27 (20%) 26 (19.9%) .98 53 (19.9%) History of valvular surgery 5 (3.7%) 4 (3.1%) .77 9 (3.4%) History of dialysis 2 (1.5%) 3 (2.3%) .63 5 (1.9%)
*Baseline characteristics are the results from surveys taken prior to the first group meeting/enrollment. History of co-morbidities taken from health system administrative data ** Analysis of primary outcomes uses differential event rates for these populations
Wilcoxon nonparametric test used for continuous measures of age, Chi-square test used for categorical variables.
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Table 3. 6 month survey outcomes - Intention to Treat and CACE (Complier-Average Causal Effect)
Control (N=106)
Intervention (N=93)
Engaged (N=26)
Model 1
CACE XO,D (N=124/131)
Model 2
CACE IPW (N=124/131)
Average
Score Average
Score Average
Score Coef
std. error
Coef std.
error
Social Support (Glasgow)
25.9 27.2 30.2
5.87*** 1.48
7.53*** 1.77
MLHF physical
21.9 21.6 18.4
-2.03 2.38
-5.29 5.22
MLHF emotional
9.3 9.6 8.5
-0.6 1.48
-1.79 2.62
MLHF total
45.9 44.5 38.7 -2.92 5.24 -8.18 11.08
X0: measurement at baseline * p <0.05, ** p<0.01, *** p<0.001 D: socio-demographic characteristics IPW: inverse probability weight
Note: Engagement (or complier) criteria include that i) patients participate in two or more classes and ii) made nine or more phone calls. Out of 93 patients who responded to 6 months follow-up survey, 26 were engaged. Out of 26 patients who engaged, 25 were used for analyses because 1 patient had a missing value in the education variable even after imputed dataset. In the Nurse Care Management (NCM) group, 106 patients responded to the 6 months follow-up survey and were used as references. Therefore 131 (=26+106) patients were potentially considered for analyses. Out of 131 patients, 7 patients who were newly diagnosed with heart failure at baseline did not provide responses about their prior heart failure specific social support (Glasgow). As a result, 124 patients were used for analysis with social support (Glasgow) while 131 for other outcomes. OLS was performed for all measurements listed in the table. Gender, education, living arrangement and each of baseline scores (Social support, MLHF physical, MLHF emotional and MLHF total) were used as control variables for analysis model 1 and predictors to obtain inverse probability weight for model 2. There were some missing values in items of composite scores (Social Support and MLHF scores). We used multiple imputations by chained equation (MICE) method to impute missing items.
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L. Strawderman, Hwajung Choi, Rebecca Mase and John D. PietteMichele Heisler, Lakshmi Halasyamani, Mark E. Cowen, Matthew D. Davis, Ken Resnicow, Robert
A Randomized Controlled Effectiveness Trial of Reciprocal Peer Support in Heart Failure
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