EMPOWER Study, a Personalized Home Care Intervention for Older Heart Failure Patients

Examining the Feasibility of EMPOWER - A Personalized Adherence Enhancement Intervention for Older Post-discharge Heart Failure Patients

The purpose of this study is to see how investigators may best improve treatment adherence and disease management for heart failure after hospital discharge. This is because the period after hospital discharge is critical to long-term recovery, overall quality of life, and prevention of future hospitalizations. In this study, a trained nurse interventionist will work with the participants to develop a personalized adherence enhancement strategy for heart failure diagnosis. The personalized adherence enhancement strategy is called EMPOWER.

Inclusion Criteria:

• diagnosis of moderate/severe heart failure at hospital admission, defined by ICD codes (ICD-9 428 or ICD-10 150), New York Heart Association class III/IV, and left ventricular ejection fraction less than or equal to 40% (i.e., echocardiography)
• discharge from heart failure-led hospitalization to home health care in approximately the previous week
• intact or mildly impaired cognitive function (Montreal Cognitive Assessment eligibility scores greater than or equal to 18)
• primary residence in four counties within 30 minutes distance to the University of Rochester

Exclusion Criteria:

• end-of-life prognosis in the following 6 months that make it difficult to examine the changes in heart failure outcomes
• currently receiving hospice care
• conditions that impact the receipt of the intervention such as active suicidal ideation that is identified at baseline using the Geriatric Depression Scale and the Geriatric Suicide Ideation Scale
• being non-English speaking
• having serious visual and or hearing impairment