Blog | Wednesday, November 12, 2008

Power to the patient! (with your encouragement)


The theme of several late-breaking trials today seems to be, very loosely, patient empowerment. To wit:

One study compared atrial fib/heart valve patients on warfarin who were monitored monthly at a clinic with those who did weekly home INR testing. There was no difference in the primary outcome-- time to death, major bleed or stroke.

This is a case where a negative outcome isn't really bad. It's good to know, the author said, that patients can test at home just as well as in a clinic, especially for those who live in remote areas or have other barriers to getting to a clinic. Plus, patients were happier with the home testing approach, and Medicare covers it for AF, heart valve and VTE patients.

Next comes a sub-study of yesterday's HF-Action study on exercise and heart failure (see earlier post for main study). This one found patients who did exercise training reported significantly better health status (quality of life, symptoms and physical/social limitations) at three months, and the difference lasted for three years.

Quality of life is important in heart failure patients, because HF is a chronic, incurable disease, discussant Anne Taylor, MD said. She noted that in this study, the subjects were receiving optimal medical therapy, and were 59 years old on average-- while in the general population, heart failure patients don't always get OMT, and are older. Study author Ileana Pina, MD, responded that the group did plan to analyze the results in an older cohort, so stay tuned.

Finally, Lori Mosca, MD, reported on her group's creative study in which researchers screened and counseled the relatives of hospitalized patients about their health risk factors. The control group got a handout about reducing risks, while the intervention group got immediate feedback on screening tests, and a year of diet and exercise counseling.

LDL levels declined in both groups after a year-- a testament to how motivating it is to see a loved on get sick, Dr. Mosca said-- but there was no difference between groups. The intervention group had a significantly better diet score and exercised more, and their HDL went up slightly, while the control group's HDL declined. Both groups significantly decreased their saturated and trans fat consumption.

Given that both groups improved their behaviors after some level of intervention, hospitals have a unique opportunity to educate, motivate and help patients' relatives, observers noted. A lot of these relatives were unaware they had CV risks, Dr. Mosca said, and that awareness alone might have spurred them to action.