LifeCourse: Lay Healthcare Workers Impact Quality of Life for Heart Failure Patients

S96 Journal of Cardiac Failure Vol. 22 No. 8S August 2016 277 No Association Found between Ischemia and Rate of Congestive Heart Failure Hospitalization Following Cardiac Resynchronization Therapy Adam C. Powell1, Erin M. Kren1, Teresa L. Rogstad2, Uday U. Deshmukh1, Stephen E. Price2, Jeffrey D. Simmons2; 1HealthHelp, LLC, Houston, TX; 2Humana Inc., Louisville, KY Introduction: The myocardial scarring resulting from ischemic coronary artery disease (CAD) can interfere with effective lead placement during the implantation of multilead cardioverter defibrillators for cardiac resynchronization therapy (CRT). Extensive myocardial scarring has been associated with poorer physiological and survival outcomes. Objective: This study evaluated whether CRT recipients with ischemic cardiomyopathy respond as well as recipients with nonischemic cardiomyopathy, using hospital admission for congestive heart failure (CHF) as a measure of response. Methods: Individuals who had undergone CRT in 2013 and had been hospitalized for CHF in the 12 months prior to implantation were identified from a large private health insurer’s claims database. Participants had to have 12 months of continuous enrollment before and after implantation. The study sample was divided into a nonischemic and an ischemic group, and a subset of the ischemic group with a diagnosis of ST elevation myocardial infarction (STEMI) was identified and considered to be representative of individuals with the greatest likelihood of scarring. The rate of CHF hospital admission in the 12 months post-implantation was computed for each group. Both the entire ischemic group and the STEMI subset were separately compared with the nonischemic group. Two-tailed p-values from Fisher’s exact test were used to evaluate the significance of the association between ischemia and post-implantation CHF hospitalization. Results: The number of people excluded for not having a CHF admission in the year prior to implant was 802, 143, and 51 for the nonischemic, ischemic, and STEMI groups respectively. No significant differences were found in the rates of post-implantation CHF admissions between the groups which were compared. CHF hospitalizations occurred in 38/200 people in the nonischemic group (19%), 17/71 in the ischemic group (24%), and 6/34 in the STEMI group (18%). The rate of CHF admissions postimplant was not significantly different in the ischemic versus nonischemic comparison (P = .39) or in the STEMI versus nonischemic comparison (P = 1.00). Conclusions: No association was found between the presence of ischemic heart disease, or even an ischemic event likely to produce a high degree of scarring, and the likelihood of being hospitalized for CHF in the year after undergoing CRT. While the small sample size limited the power of the study, in all of the groups, people had a ≤ 24% chance of CHF admission in the year post-implantation, although they had experienced a CHF admission in the year prior. Thus, no evidence was found to suggest that physicians should be advised to restrict the use of CRT in patients with a history of ischemic heart disease or evidence of myocardial scarring.

278 LifeCourse: Lay Healthcare Workers Impact Quality of Life for Heart Failure Patients Tetyana Shippee1, Nathan Shippee1, Patrick Mobley2, Karl Fernstrom2, Heather Britt2, Peter Eckman2; 1University of Minnesota, Minneapolis, MN; 2Allina Health, Minneapolis, MN Introduction: Heart failure has a significant adverse impact on quality of life. LifeCourse is a late life supportive care approach that aims to maintain or improve quality of life and care experience and improve service utilization for people living with serious illness. Lay healthcare workers called care guides collaborate with physicians, care teams and community partners to help patients and their friends and family navigate advancing disease. Care guides meet with patients in their home and help them ask the right questions, connect with needed support and prepare the next steps in their care. LifeCourse assists healthcare providers in recognizing and honoring individuals’ preferences, and supporting individuals making difficult healthcare decisions. Hypothesis: Patients with heart failure participating in LifeCourse maintain quality of life (QOL) longer than patients receiving usual care. Methods: To date, 438 patients (54% intervention) have enrolled in this observational study. Patients were selected based on electronic health record criteria (emergency department and inpatient utilization, heart failure diagnosis, and comorbidity index) and a chart review by an experienced registered nurse. Selected patients were not yet eligible for hospice but sick enough to receive benefits of a supportive care approach two to three years prior to death. We used a subsample with at least 6 months follow-up (216 patients) for the analysis. Patient QOL is measured quarterly using the Functional Assessment of Chronic Illness Therapy—Palliative (FACIT-Pal) survey. A robust six-month change score model was used to test the hypothesis—adjusted for confounding demographic variables: age, gender, race, marital status, and education. Results: 121 patients with heart failure (52% male; mean: age 77 ± 2, baseline QOL 137 ± 5) were compared to 95 control patients with heart failure (43% male; mean: age 75 ± 2, baseline QOL 137 ± 6). After 6 months of follow-up, LifeCourse patients scored on average 6 ± 4 points higher on QOL than usual care participants (P = .015). Additionally, LifeCourse was most effective for patients with lower baseline QOL scores. For patients scoring in the bottom third, LifeCourse patients scored on average 11 ± 8 points higher than usual care (P = .009). Conclusions: LifeCourse fills a gap in late life care for patients with heart failure, and may be most effective when QOL is lowest. For patients with higher QOL, LifeCourse helps maintain QOL compared to usual care.