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

Impacts on Caregiver-reported Outcomes

Abstract

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.