Improving Symptoms and Quality of Life in Chronic Heart Failure: Pilot Study
Improving Symptoms and Quality of Life in Chronic Heart Failure: Pilot Study
The overall goal of this study is to evaluate the pilot implementation of two palliative care
 interventions in veterans with chronic heart failure at the Denver VA Medical Center. This is
 a study of behavioral and care strategy interventions and involves no investigational drugs
 or devices.
The investigators will examine the feasibility of two palliative care interventions designed
 to improve different facets of quality of life. Briefly, the two interventions are:

 1. A palliative symptom management and psychosocial care intervention named Collaborative
 Care to Alleviate Symptoms and Adjust to Illness (CASA) that includes

 1. evidence-based palliative symptom management of breathlessness, fatigue, and pain,
 provided by a nurse;

 2. a 6-session structured psychosocial care protocol targeting depression and
 adjustment to illness, supplemented by informal (family) caregiver assessment and
 support, provided by a social worker or psychologist; and

 3. brief weekly team meetings with the nurse, social worker/psychologist and a
 palliative care specialist, cardiologist, and primary care provider.

 2. A psychospiritual intervention that is home-based, self-guided, and requires minimal
 resources. It will be delivered in written modular form via US Mail along with brief
 weekly telephone support.

 The specific aims of the study are to:

 1. Examine intervention feasibility and determine preliminary estimates of intervention
 effect

 1. Determine patient participation rates and cohort retention

 2. Conduct a preliminary assessment of outcomes by measuring pre-post changes in
 quality of life, depressive symptoms, health status, life meaning, and
 spirituality.

 2. Obtain qualitative feedback from study participants, the persons providing the
 intervention, and providers/leaders in primary care, mental health, palliative care,
 chaplaincy, and hospital operations.
Inclusion Criteria:

 -  eligible veterans from the Denver VAMC will have a prior primary discharge diagnosis
 of heart failure in the last year,

 -  be at least 18 years of age, able to read and understand English,

 -  have consistent access to a telephone

 -  at least one of the following:

 1. Kansas City Cardiomyopathy Questionnaire (KCCQ) score less than or equal to 60;

 2. a second hospitalization for with a primary discharge diagnosis of heart failure
 in the last year;

 3. taking at least 80 mg oral furosemide (or equivalent) daily in a single or
 divided dose for at least 2 weeks;

 4. BNP greater than or equal to 250 or NT-proBNP greater than or equal to 1000; or

 5. estimated creatinine clearance 30-80 mL/min.

 Exclusion Criteria:

 -  previous diagnosis of dementia;

 -  active substance abuse, defined as an AUDIT-C score greater than 7, two positive
 responses on substance abuse screening questions, or medical records indicating active
 substance abuse or dependence;

 -  comorbid metastatic cancer, given the focus on heart failure palliative care;

 -  nursing home resident; and

 -  diagnosis of bipolar disorder or schizophrenia.