Result card

  • EFF7: What is the effect of Structured telephone support (STS) on generic health-related quality of life of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?
English

What is the effect of Structured telephone support (STS) on generic health-related quality of life of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?

Authors: Mirjana Huic, Pernilla Östlund, Romana Tandara Hacek, Jelena Barbaric, Marius Ciutan, Cristina Mototolea, Silvia Gabriela Scintee

Internal reviewers: J. Puñal, J. Gonzalez-Enriquez, H. Stürzlinger, A. Lo Scalzo, S. Maltoni

Acknowledgments: We would like to thank Ms Ana Utrobičić, MLIS, the Head of the Central Medical Library at the University of Split School of Medicine, Split, Croatia for development of systematic literature search strategy and performed search on standard medical and HTA databases.

The same methodology was used as described in section for the whole domain.

Assessment element questions D0012 and D0013 (EFF7 and EFF8) were answered together:
Three SRs were used to answer ”What is the effect of Structured telephone support (STS) on generic health-related quality of life of adults with chronic heart failure, compared to standard care without  Structured telephone support (STS)?” and ”What is the effect of Structured telephone support (STS) on disease specific quality of life of adults with chronic heart failure, compared to standard care without Structured telephone support (STS)?” {Feltner 2014, Pandor 2013, Inglis 2011}, with 8 RCTs overlappin with those from our sample of 19 RCTs {Riegel 2006, Angermann 2012, Barth 2001, Wakefield 2008, DeWalt 2006; GESICA 2005; Ramachandran 2007; Sisk 2006}. Data found was controversial, but majority presented statisticaly significant QoL improvements.

 

In the most recent SR and HTA published by Feltner et al, 2014 { } STS interventions did not improve HF-specific quality of life at 3 or 6 months. Meta-analysis {Feltner et al, 2014} (two trials, Riegel et al, 2006 and Dominiquez et al, 2011) found no difference in Minnesota Living With Health Failure Questionnaire (MLWHFQ) scores among patients receiving STS and those receiving usual care at either 3 months (WMD, -3.78; 95% CI, -10.39 to 2.83) or 6 months (WMD, -7.14; 95% CI, -21.07 to 6.78).

Three additional trials reported on quality of life at 6 months {Angermann et al, 2012, Dunagan et al, 2005, Barth et al, 2001}; in one trial, patients receiving STS had significantly better NYHA classification and SF-36 physical functioning subscale and physical health summary measure scores at 3 months than patients receiving usual care {Angermann et al, 2012}. Another trial reported on physical and emotional subscales of the MLWHFQ and on physical and mental health summary measures of the SF-12; patients receiving STS had significantly better scores on the SF-12 physical scale than controls at 6 months, but all other comparisons were not significant {Dunagan et al, 2005}.

Barth et al, 2001 { } found no significant difference between the groups in the emotional dimension of the questionnaire prior to discharge (t = .36, p = .718) or the physical dimension of the questionnaire prior to discharge (t =.83, p = .414). The total scores for the two groups on the LHFQ were not significantly different (t = .22, p =.829) before discharge from the acute-care setting. A t test for paired samples was done on the scores of the LHFQ obtained from the participants at the conclusion of their involvement in the study. Within the control group, the comparison of means on the emotional dimension of the LHFQ predischarge with the emotional dimension of the LHFQ at the conclusion of the study revealed that there was not a statistically significant difference (t = 2.53, p = .022). There also was not a statistically significant difference between the prescores and postscores in the control group on the physical dimension (t = .93, p = .367) or for the total scores (t = 1.81, p = .088).

A paired sample t test was used to determine if there was a difference in LHFQ scores prior to discharge and at the study conclusion for the experimental group. All three areas were found to be statistically significant, with participants showing improvement in their perceived quality of life at the conclusion of their involvement in the study. Participants in the experimental group showed significant improvement in the physical dimension (t = 6.63, p ≤.0005), the emotional dimension (t = 4.55, p ≤ .0005), and the total LHFQ score (t = 7.80, p ≤ .0005).

 

Pandor et al, 2013 { } showed that STS improved QoL. Three of the four STS studies reported improvements in QoL {Angermann 2012, Barth 2001, Wakefield 2008}, with significant improvements in physical (p = 0.03) {Angermann 2012} and overall (MLHFQ, p < 0.001) measures {Barth 2001, Wakefield 2008}. One study found no significant differences between groups in either the MLHFQ or the EQ-5D measure {Riegel 2006}.

 

In SR published by Inglis et al, 2011 { }, Quality of Life (QoL) was a secondary outcome for 16 of the 30 included studies.

Several different psychometric tools were used for evaluation (Chronic Heart Failure Symptomatology Questionnaire (CHFSQ); Minnesota Living with Heart Failure Questionnaire (MLWHFQ); Kansas City Cardiomyopathy Questionnaire (KCCQ); Short Form 12 Item (SF-12); Short Form 36 Item (SF-36) and Health Distress Score (HDS)).

Six structured telephone support studies {Angermann 2007; DeWalt 2006; GESICA 2005 (DIAL); Ramachandran 2007; Sisk 2006; Wakefield 2008} demonstrated a significant improvements in component scores or overall QoL measures. Studies which assessed both telemonitoring and structured telephone support {Cleland 2005, Mortara 2009} did not report QoL outcomes.

Details could be found in Appendix 3 and 4.

Important
Partially
Huic M et al. Result Card EFF7 In: Huic M et al. Clinical Effectiveness In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 21 June 2021]. Available from: http://corehta.info/ViewCover.aspx?id=305

References