MyROAD audio instruction card improved clinical outcomes following HF hospitalization
The MyROAD pre-recorded audio instruction card for at-home care and self-management improved 30-, 45- and 90-day clinical outcomes in patients following HF hospitalization.
“MyROAD stands for, 'My Recorded On-Demand Audio Discharge instructions.' We all know that heart failure is a complex condition,” Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, associate chief nursing officer of the Office of Nursing Research and Innovation at Cleveland Clinic Health System and a clinical nurse specialist at the Kaufman Center for Heart Failure at Cleveland Clinic, said during a presentation at the virtual American Heart Association Scientific Sessions. “When in the hospital, many professionals discuss the plan of care with patients, but messages may be inconsistent, or patients and families may miss important content. On the day of discharge, patients are distracted, and paperwork may seem overwhelming. We worked with American Greetings to develop a card that provided brief, consistent audio messages that were actionable and can be repeated.”
When the MyROAD card is opened, it plays a 35-second message informing the patient that each of its four buttons will cover important information regarding their HF care. Each button played a 35 to 40 second message covering themes including physical activity, diet, medications and self-monitoring.
The card also contains a magnet that allowed it to be hung on metal surfaces such as a refrigerator.
For the randomized controlled trial, researchers enrolled 997 adults hospitalized with HF (mean age, 73 years; 59% men; 24% Black) and randomly assigned them to receive the MyROAD instruction card plus standard care or standard care alone. Participants were followed up for 6 months via phone calls or medical record review. Patients were encouraged to share the messages with their caregivers.
Researchers hypothesized that the MyROAD intervention would decrease all-cause and HF hospitalization; all-cause and HF ED visits; and 30-, 45-, 90- and 180-day all-cause and HF death after hospital discharge.
The Charlson Comorbidity Index and medications at discharge were similar between the two groups.
Compared with standard care alone, researchers found that individuals assigned to the MyROAD intervention experienced:
- 27% fewer all-cause ED visits at 30 days and 29% fewer at 45 days;
- 40% less all-cause death and 50% less HF death at 90 days;
- no improvement in re-hospitalization; and
- fewer composite events of all-cause readmission, ED visits or death at 30 and 45 days.
In addition, participants in the MyROAD group were 40% less likely to need a heart-assist device, to undergo heart transplantation or to die from any cause at 3 months post-discharge.
“The effect of the MyROAD card intervention was generally consistent across most specified subgroups,” Albert said during the presentation. “There was a potentially greater treatment effect among females; non-white patients; patients with high school or higher education level; patients that perceived they did not have enough finances to meet their normal daily needs; patients who were not discharged on a renin-angiotensin system agent, a beta-blocker or a mineralocorticoid receptor blocker; and those who received zero to one heart failure core medications vs. two to three heart failure core medications.”
Discussant Erica S. Spatz, MD, MHS, associate professor of cardiovascular medicine in the Center for Outcomes Research and Evaluation at Yale School of Medicine, said during the press conference that “These digital therapeutic tools are used to engage patients so that they can activate patients so they can be more involved in their health care decisions. The idea here is that an empowered informed patient has a better chance at having a high-quality discussion with their clinician and be better able to engage in shared decision-making. In the MyROAD trial, patients are armed with information so that they can make better decisions for themselves when they're home and have a better guide for how to implement self-care and management.”
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Albert NM, et al. LBS.09: High tech or high touch: Creative strategies to optimize patient care. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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