Symptom Care at Home-Heart Failure: Developing and piloting a symptom monitoring and self-management coaching system for patients with heart failure

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This is a K23 award application for Dr. Youjeong Kang, an experienced clinician in inpatient and home health care settings, to independently develop and test innovative interventions for heart failure (HF) management that are effective and scalable, as well as improve care for HF patients. The K23 will provide her the support necessary to acquire critical skills in four key career development areas: 1) enhance expertise in HF symptoms and self-management based on patient-reported outcomes (PRO) data; 2) develop expertise in clinical trial design and implementation for the home-based symptom management intervention testing; 3) acquire further professional development and leadership skills; and 4) obtain skills in developing and adapting technology-aided interventions (i.e., app-based platform). To achieve her goals, Dr. Kang has assembled an interdisciplinary mentoring team comprised of Drs. Kathi Mooney (Primary Mentor), an internationally recognized expert in oncology symptom management using telephone-enabled interventions; Josef Stehlik (Co-Mentor), an experienced cardiologist with an independent research career focused on HF treatments; and Gary Donaldson (Advisor), an expert in multivariate longitudinal statistical analyses. Keeping HF patients at home with a low symptom burden after hospital discharge is challenging. Evidence shows that delay in HF symptom recognition and poor self-management are associated with unplanned emergency department visits and rehospitalizations. Clinical trials aimed at preventing rehospitalization using telemonitoring have shown limited utility suggesting that monitoring physical changes alone may not be sufficient to maintain stability of HF patients at home. A recent cancer study has demonstrated that patients receiving cancer chemotherapy achieved a 40% reduction in symptoms using Symptom Care at Home (SCH), a computer-interface telephonic interactive voice response system pairing patient-reported symptoms with automated real-time, self-management coaching. While a few HF studies have used interventions that monitored symptoms, no studies have tested a system that monitors and provides real-time, self-management coaching tailored to specific PRO. Dr. Kang’s objective is to pilot an adaption of the SCH system to HF resulting in preliminary data to support a fully-powered randomized control trial to test an adapted SCH-HF system that could be widely disseminated. She proposes the following Specific Aims over two-parts: Aim 1] Tailor the real-time self-management coaching system to integrate HF symptom monitoring and self- management coaching into the SCH-HF system; and Aim 2] Conduct a pilot randomized controlled trial (RCT) to assess the feasibility, acceptability, and preliminary efficacy of the SCH-HF system. The proposed research is significant because it expands our understanding into HF symptom monitoring and management using PRO in the home setting. The proposal is innovative because it integrates HF clinician and patient perspectives to develop a daily home monitoring and real-time self-management coaching system.