Predicting hospitalisation in heart failure using PROMs
Research type
Research Study
Full title
Predicting hospitalisation in heart failure: incorporating dynamic patient-reported measures in a prognostic model to improve outcomes
IRAS ID
278967
Contact name
Claire Lawson
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
3 years, 1 months, 3 days
Research summary
Summary of Research
Heart failure (HF) is a serious condition that leads to people experiencing many symptoms, feeling poorly and spending a lot of time in hospital. Patients with HF are often older and have other conditions that can cause them to be hospitalised. Before admission, patients will usually start to feel worse, but they are often confused as to what might be causing their increasing symptoms. They may try to ignore their symptoms and not ask for help early enough. It is thought that over half of hospitalisations could be avoided if we could identify these patients earlier. There are risk assessment tools to help identify HF patients who might need to be hospitalised but these tools only include medical information and they are not very accurate. They do not include symptoms or keep regular checks on patients to see if they are getting worse. The overall aim of my research is to develop a better assessment tool for identifying patients with HF who are getting worse before their symptoms become so serious that they need to be hospitalised. This project will answer two key questions. Firstly, which ‘patient reported outcome measures (PROMs)’ relating to symptoms and health should we ask patients regularly to identify deterioration? Using emails, 25 HF patients/carers and 25 clinicians will be invited to select PROMs that relate to HF and other conditions. A patient/carer meeting will then be held to get final agreement. Secondly, will patients want and be able to record PROMs regularly? Guided by question 1 results, I will ask 60 patients to make a note of their symptoms weekly, using a simple and quick electronic application (ePROHF). I will study how many patients are willing and able to do this and I will ask them about their experiences, using postal questionnaires.
Summary of Results
Heart failure is a serious condition that often leads to worsening symptoms and frequent hospitalisations. The aim of my fellowship was to develop an assessment tool to identify deteriorating health in patients with heart failure before hospitalisation is necessary.
The first two studies investigated whether changes in symptoms and health had similar implications for hospitalisation risk across different patient groups with heart failure. Using heart failure databases from Sweden and Asia, including over 30,000 patients, I found that changes in symptoms and health consistently indicated risk of hospitalisation, regardless of sex, ethnicity, socioeconomic status, or type of heart failure.
In the third study incorporating three questionnaires and a meeting I engaged 28 patients and carers and 35 healthcare professionals to rate a set of 24 symptoms and health measures on their importance prior to hospitalisation. A final core set of eight symptoms were selected for routine monitoring by patients. This ‘core outcome set’ is now adopted by a national group (Core Outcome Measures in Effectiveness Trials) for use in routine care.
In the final study, 25 patients with heart failure used a simple mobile application (ePRO-HF) to record their symptoms and health over 6-months. Most (88%) patients used the app at least weekly and found it helpful for monitoring symptoms and weight, understanding symptom changes, and found it an acceptable monitoring method. Overall, my fellowship suggests that a simple patient-centred app is a feasible and acceptable tool for heart failure patients to monitor their symptoms and health. With hospitalisation rates increasing for heart failure patients and many potentially avoidable, self-monitoring could play a crucial role in early detection of deterioration. Further research is needed to improve communication of symptoms and health status to healthcare professionals and to explore the inclusion of prompts to support patients to seek timely medical advice.
REC name
East of England - Cambridgeshire and Hertfordshire Research Ethics Committee
REC reference
20/EE/0162
Date of REC Opinion
7 Aug 2020
REC opinion
Further Information Favourable Opinion