Collaborative Care to Alleviate Symptoms and Adjust to Illness in Chronic Heart Failure (CASA) Trial (CASA)
Chronic Heart Failure
About this trial
This is an interventional treatment trial for Chronic Heart Failure focused on measuring Quality of Life, Symptoms, Palliative care, Symptom management, Disease management, Health delivery
Eligibility Criteria
Inclusion Criteria:
- Age 18 years of age or older
- Able to read and understand English
- Consistent access to a telephone
- Patients have a primary care or other provider who is willing to facilitate intervention medical recommendations
- A diagnosis of heart failure with at least one of the following:
[hospitalization primarily for heart failure in the year prior (including current); taking at least 20 mg oral furosemide (or equivalent) daily in a single or divided dose; Brain natriuretic peptide(BNP) ≥ 100 or N-terminal prohormone of brain natriuretic peptide(NT-proBNP) ≥ 500; EF≤40%]
- Report a low health status (KCCQ-SF≤70)
- Bothered by at least one target symptom:
[Pain; Depression; Fatigue; Breathlessness]
Exclusion Criteria:
- Previous diagnosis of dementia
- Active substance abuse or dependence, defined by either a diagnosis of abuse or dependence or an AUDIT-C ≥ 8, or self-reported substance abuse in the past 3 months
- Comorbid metastatic cancer
- Nursing home resident
- Heart Transplant recipient
- LVAD recipient
Sites / Locations
- University of Colorado Hospital
- Denver Health
- VA Eastern Colorado Health Care System(ECHCS)
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
CASA Intervention
Usual Care
The CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) intervention includes 3 components: A nurse (RN) follows structured algorithms to help patients with symptoms, specifically breathlessness, fatigue, pain, and depression. A social worker provides structured counseling targeting adjustment to illness and depression if present. A collaborative care model of care delivery, in which the nurse and social worker meet weekly with a primary care provider, cardiologist and palliative care specialist. This team makes medical recommendations to the intervention subjects' providers and supervises the nurse and social worker. Most of the nurse and social worker visits are by phone.
Patients in the control group will continue to receive care at the discretion of their providers, which may include referral to cardiology, palliative care, or mental health. If patients self-report depression on baseline surveys, this information will be given to their provider, and patients will be given resources. Patients will have the same amount of interaction with research assistants as the intervention patients, completing questionnaires and participating in study visits at the same frequency.