Research Summary

Piloting a quality improvement intervention for the optimal medical management of patients with chronic heart failure (PANACEA-HF).

Heart failure is a condition characterized by a poor quality of life, owing to distressing smptoms, repeated hospitalizations and multi- morbidity. Its prevalence in India is increasing. Heart failure patients tend to get re-hospitalized frequently due to fluid retention and severe breathlessness. Western studies that have employed ‘task-shifting’ interventions have shown that educating patients in self care (follow certain lifestyle measures, take their medications properly) and closer follow-ups, can reduce re-hospitalization rates, thus saving costs. While technology that bridges patient - care provider gap has been evaluated priorly in trials, we need more evidence to establish efficacy.

In this study, we will train lay health workers to educate patients with heart failure and/or their caregivers to record their own blood pressures and body weight as well as follow lifestyle modification, at the time point of discharge. The health worker will also enter the treatment plan (medications to be taken, dose, time of day etc) into the application at discharge. Centrally, the health worker will be equipped with a tablet. The mHealth system will be smart enough to alert the health worker to abrupt changes in body weight or uncontrolled BP. The health worker will work with the treating physician to take appropriate action (diuretic/ ACE-ARB/ beta blocker dose titration etc). The application will also prompt patients to take their medications. The health worker will make at least one home visit. Patients will be followed up for a year. We will employ an open label, individual patient, randomized controlled trial design (n = 230), with a 1:1 allocation ratio. Effects on all cause re-hospitalization and mortality will be documented, apart from a range of other clinical outcomes.