Post-discharge short message service improves short-term clinical outcome and self-care behaviour in chronic heart failure

Abstract

Aims: In addition to giving optimal medical and device therapy, promoting self-care of chronic heart failure (CHF) patients also plays an important role in comprehensive disease management for better outcomes. The study was aimed to investigate whether short message service (SMS) would help to improve death or readmission-free survival and self-care behaviour in CHF patients.

Methods and results: This was a randomized controlled trial. Between December 2011 and September 2015, patients admitted with decompensated CHF in a tertiary referral hospital who fulfilled the inclusion criteria were enrolled and randomized to receive SMS, structured telephone support (STS), or usual care after discharge. All patients were followed up to 180 days after discharge by phone call or clinic visit. Primary endpoint was the 180 day composite event, defined as all-cause mortality or readmission. Secondary endpoints included self-care behaviour and quality of life. Seven hundred sixty-seven patients (61 ± 15 years, 56.5% male) were finally randomized to receive SMS (n = 252), STS (n = 255), or usual care (n = 260). Baseline characteristics were similar among the three groups. Five hundred twenty-five (68.4%) patients were in New York Heart Association Class III or IV, and 472 (61.5%) patients had an ejection fraction of <50%. During a 180 day follow-up, 76 (9.9%) patients died and 274 (35.7%) patients experienced at least one readmission. In a short-term follow-up of 30 days, there was no difference in mortality and the composite endpoint among the three groups (SMS vs. STS vs. usual care: 2.8% vs. 3.1% vs. 3.8% for mortality, P = 0.786; 12.3% vs. 14.5% vs. 15.4% for the composite endpoint, P = 0.588). The 180 day composite event rate was significantly lower in the SMS and STS groups (50.4% vs. 41.3% and 36.5%, both P < 0.05) than in the usual care group, but no difference was observed between the two phone-based intervention groups (P = 0.268). Although there was no difference between the two groups, better self-care behaviour was reported in the SMS and STS groups than in the control group (medication compliance, 78.9% vs. 81.4% vs. 69.5%, P = 0.011; water restriction, 70.8% vs. 74.5% vs. 61.5%, P = 0.013). Quality-of-life score was similar among the three groups at 180 days (P = 0.526).

Conclusions: In CHF patients, post-discharge SMS, which appeared as efficient as STS, reduced the 180 day composite event and improved self-care behaviour. SMS intervention could be integrated into CHF management.

Keywords: Chronic heart failure; Composite endpoint; Self-care behaviour; Short message service; Structured telephone support.

Figure 1

Sample message by SMS (in Chinese originally and in English for demonstration).

Figure 2

Flow chart of the study.

Figure 3

Kaplan–Meier survival analysis among three groups.