Chronic heart failure (CHF) is a serious, costly chronic disease affecting nearly 6 million Americans and 12% of older adults. People with CHF are instructed to perform self-care management, consisting of: monitoring themselves for symptoms, recognizing symptoms and other changes, evaluating symptom severity, and taking actions such as seeking medical assistance or taking extra doses of medication. However, studies show many patients with CHF fail to detect symptoms or changes in status, misinterpret or misevaluate symptoms, do not take responsive action, or choose the wrong response. This study will design and test an information technology called Power to the People (P2P) to support self-care management among older patients with CHF. P2P is unique in using data from these patients? cardiovascular implantable electronic devices (CIEDs), which collect many types of data correlated with worsening CHF. CIED data will be used in combination with self-reported data (e.g., weight, fatigue, diet) to present patients with visual displays and recommendations for action, as well as to inform clinicians. The study is also unique in its emphasis on usable design for older adults through user-centered design. The 18-month study?s specific aims are to design and test the P2P information technology system. Specifically:
Specific Aim 1 : Design novel interactive, prototypes of Power to the Patient (P2P) to inform and support CHF self-care management. In Phase A of this aim, the study will recruit 24 adults aged 65 and older, diagnosed with systolic or systolic/diastolic heart failure, and implanted with a CIED. Participants will perform cognitive task analysis interviews using two age-appropriate roleplay scenarios. Additional data will be collected using standardized surveys. Cognitive task analysis findings will be analyzed using protocol analysis and summarized to support prototype design. In Phase B, prototypes will be developed through iterative design sessions and regular review by a user advisory board.
Specific Aim 2 : Assess the usability and acceptability of P2P prototypes for older adults with CHF. For this aim, the study will perform expert review of P2P prototypes, followed by laboratory-based usability testing of the prototypes by 24 additional older adults with CHF. Usability testers will perform a series of structured tasks using the P2P and complete surveys about their perceptions and acceptance of P2P. Following evaluation of the prototypes, P2P will be refined and readied for a future clinical trial of P2P effectiveness relative to usual care with CIED remote monitoring. Older adults with CHF and other chronic diseases are a priority population. They represent a vulnerable group of individuals whose health is at risk from inadequate self-care management. Improving self-care management with technology by supporting decision making and timely, appropriate responses can improve the health of this population and reduce costs associated with hospitalization and use of acute care services.
This project will design and test information technology for older adults with chronic heart failure. The Power to the Patient system will use data from implanted electronic devices to help heart failure patients manage symptoms and take quick and appropriate actions to protect their health. The project will learn how older adults with heart failure make decisions, use this knowledge to create designs, and test the designs for usability and acceptance.
