Efficacy of Automated Digital Counseling for Chronic Heart Failure (ODYSSEE-vCHAT-CHF): A Randomized Controlled Pilot Trial (Preprint)
Notice bibliographique
Résumé
BACKGROUND Chronic Heart Failure (CHF) is an increasing health burden associated with psychological distress, decreased quality of life, and high one year hospitalization rates (40%). CHF patients benefit from appropriate self-care and there is an increasing need for automated scalable programs to motivate and educate these patients. OBJECTIVE A Virtual Community Promoting Health Literacy, Self-care and Peer Support for Heart Failure (vCHAT-CHF Trial) used an automated scalable digital program: prOmoting health with DigitallY based counSeling of Self-care bEhavior and quality of life (ODYSSEE) to improve adherence and self-care in CHF patients, thereby improving health and health-related quality of life vs. enhanced usual care (eUC). The primary outcome was a composite index of all-cause hospitalization and emergency room (ER) visits. Secondary outcomes included changes in self-reported physical and psychosocial well-being. METHODS The vCHAT-CHF Trial was a 2-armed single-blind randomized control pilot trial. This was an evidence-based online multimedia digital health platform, based on cognitive behavioral and motivational interviewing techniques. ODYSSEE-vCHAT employed weekly topics on an interactive digital health platform, as well as weekly webcast presentations on various self-care themes and moderated online chat rooms, in addition to usual care. RESULTS 61 CHF patients recruited from three tertiary hospitals in Canada were enrolled in the program for a median of 7 months. 44 (72%) of participants completed the endpoint assessment questionnaires (n= 19 (63%) in ODYSSEE-vChat vs. 25 (81%) in enhanced Usual Care (eUC)). Primary and secondary outcomes were investigated through linear and/or logistic multivariate models as appropriate, comparing program groups (e.g. ODYSSEE-vCHAT vs. eUC) by both intention-to-treat and treatment-received methods. ODYSSEE-vCHAT was not associated with a composite of unplanned hospitalizations and/or ER visits in the current trial (23% usual care vs. 23% ODYSSEE, P = .78). However, multivariate logistic regression demonstrated that individuals in ODYSSEE-vCHAT (vs. eUC) were more likely (P = .003, OR = 6.0) to show clinically relevant change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) as defined by a change score ≥ 5 from baseline to end of trial. Multivariate linear regression showed that ODYSSEE-vCHATwas also associated with positive change in Self-Efficacy for Managing Chronic Disease (SEMCD6; P = .03, B = 4.38). CONCLUSIONS In summary, the vCHAT-CHF pilot trial showed that ODYSSEE-vCHATwas associated with clinically relevant change on the KCCQ and an increase in self-efficacy in management of chronic disease vs eUC, but failed to show a difference in number of hospitalizations and unplanned ER visits. This trial illustrated the potential of evidence-based automated digital health programs in self-management of CHF. Future research with a larger sample size may illuminate further relationships. CLINICALTRIAL ClinicalTrials.gov NCT04966104.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».