Document Type

Final Project

Graduation Date

Spring 5-4-2024

Degree Name

Doctor of Nursing Practice

First Advisor

Jennifer Miller

Abstract

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased pulmonary artery pressures before clinical signs of decompensated heart failure, and improve patient quality of life (Haynes et al., 2020). The focus of this project will be to improve patient compliance with daily remote CardioMEMs® readings using patient reminders beyond the standard of care within the Nebraska Medicine healthcare network.

Purpose Statement

The purpose of this quality improvement project is to evaluate the effects of increased CardioMEMs® education and bi-weekly adherence reminders on CardioMEMs® compliance, heart failure-related symptoms, physical and social functioning, self-efficacy, knowledge, quality of life, patient activation, and health care utilization.

PICOT: In ambulatory heart failure patients with a CardioMEMs® device, how do a preimplant education session and bi-weekly text messages affect adherence over two-months?

Objectives:

1. The purpose of this quality improvement project is to evaluate the effects of increased CardioMEMs® education and bi-weekly adherence reminders on data transmission rates, heart failure-related symptoms, physical and social functioning, self-efficacy, knowledge, quality of life, patient activation, and health care utilization (outpatient clinic visits, emergency room visits, and 30-day hospital re-admissions).

2. Compare retrospective cohort and prospective cohort CardioMEMs® adherence data.

3. Perform comparison statistical analyses for retrospective cohort and prospective cohort CardioMEMs® adherence data comparing adherence rates from retrospective review of January 2022-December 2022 and two months following CardioMEMs® implant for the prospective cohort.

Methods:

Design: This is a quality improvement study with retrospective cohort chart review and prospective cohort intervention analysis.

Setting and participants: Participants will be recruited by the Nebraska Medicine Heart Failure Services line.

Outcome and measurements: The primary outcome measure will be CardioMEMs® compliance with at least six out of seven days of the week, or 85% compliance. Secondary outcome measures include the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Patient Activation Measure (PAM), and health care utilization which will be collected at enrollment and two months post-study intervention. Study participants will also receive enhanced education, which will be an individualized Zoom education session with a member of the Doctoral of Nursing Practice (DNP) student research team approximately one week prior to CardioMEMs® implant.

Analysis: Descriptive statistics (counts and percentages) were used to measure patient adherence. The difference in adherence was assessed with a Wilcoxon signed-rank test. Relationships between demographic and outcomes variables were assessed using Pearson's correlational methods.

Results:

A total of 10 participants were enrolled in the study, n=8 male and n=2 female. A total of 10 participants completed the pre-implant education. Average CardioMEMs® compliance from the retrospective cohort was 75% with the prospective cohort having 81% compliance.

While the compliance in the intervention group (Median = 85.0) was higher than compliance for the previous year (Median = 74.8), a Mann-Whitney U test indicated that it was not significantly different U = 74.0, p = .381. While this was not statistically significant, it was clinically significant. Amongst the study participants, our results did show a statistical significance in the decrease of 30-day hospital re-admission rates/HCU3 (U= 1.5, p = 0.020) between those with higher compliance rates (median = 100%) compared to those with lower compliance (median= 67%). Over half (60%, 6) of participants experienced an increase in their diuretic therapy.

A total of n=9 participants had pre- and post-survey results completed. Using a Wilcoxon singed Rank test, he median differences between baseline PAM and 12-week PAM scores equals 0; p= 0.672 (p

Conclusion:

A preimplant education session and increase in weekly SMS reminders to biweekly did improve daily remote CardioMEMs® reading transmission in our study group to the pre-study established goal of 85% compliance. The remote education session has the potential to be streamlined to independent learning for CardioMEMs® patients or complete remotely for convenience of the patient and the educating nurse as all sessions in this study were done remotely. Further research is needed to study factors that impact patient compliance in this population, while accounting for heart failure-related symptoms, physical and social functioning, self-efficacy, knowledge, quality of life and patient activation in the patient with a CardioMEMs® device.

Download

Share

COinS