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A Randomized Trial of Mobile Health Support for Heart Failure Patients and Their Informal Caregivers

Impacts on Caregiver-reported Outcomes

Piette, John D. MSc, PhD*,†,‡; Striplin, Dana MHSA*,†; Marinec, Nicolle MPH*,†; Chen, Jenny MPH*,†; Aikens, James E. PhD§

doi: 10.1097/MLR.0000000000000378
Original Articles

Background: Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers’ efforts.

Objectives: To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management.

Research Design: Randomized comparative effectiveness trial.

Subjects: A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system. All patients participated with a “CarePartner” or informal caregiver outside their household.

Intervention: Patients randomized to “standard mHealth” received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. “mobile health+CarePartner” (mHealth+CP) patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners.

Measures: At baseline, 6, and 12 months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support.

Results: mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months (both P≤0.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (P≤0.03 for interactions between arm and baseline strain/depression at both endpoints). Although most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all P<0.05). mHealth+CP CarePartners reported more frequently attending patients’ medical visits at 6 months (P=0.049) and greater involvement in medication adherence at both endpoints (both P≤0.032).

Conclusions: When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners’ engagement in self-care.

*Ann Arbor Department of Veterans Affairs Center for Clinical Management Research

Department of Health Behavior and Health Education, School of Public Health, University of Michigan

Department of Internal Medicine, School of Medicine, University of Michigan

§Department of Family Medicine, University of Michigan, Ann Arbor, MI

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The trial was registered in on 11/08/2007 (#NCT00555360) and funding began in July 2008. The study was approved by the Ann Arbor VA Healthcare System’s Human Subjects Committee on February 18, 2008.

David Aron, MD, MD; Kimberly Schaub, PhD; and Julie Gee, NP, were key collaborators and clinicians at the Louis Stokes VA in Cleveland,OH. The study was funded by VA Health Services Research and Development Program (HSR&D) grant #IIR 07-185. J.D.P. is a VA Senior Research Career Scientist. Additional financial support came from grant number P30DK092926 from the National Institute of Diabetes, Digestive and Kidney Diseases.

The authors declare no conflict of interest.

Reprints: John D. Piette, MSc, PhD, Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail:

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