Study of Reminding to Improve Medication Adherence in Heart Failure

A pilot and feasibility randomized trial of two medication reminder systems for patients with heart failure (HF). The investigators believe that medication reminder systems will improve adherence and will reduce the effects of cognitive impairment on medication adherence. The investigators believe that patients will accept and use a medication reminder system, but the investigators cannot specify which system will be preferred. Each has different features which may be perceived as more or less desirable.

The investigators will enroll 60 patients with HF and randomize them to four conditions in a 2 (device 1 versus device 2) by 2 (Active versus Passive) design. After enrollment in the trial, patients will be consented and will complete pretesting at Summa Health System in the Center for Clinical Trials. They will primarily undergo brief computerized cognitive testing, complete self-report measures (e.g., quality of life, depression, self-management related social support), and will give consent for medical information to be collected from their electronic medical record. They will then be randomized to condition. In-home training will be provided regarding how to use the equipment. Medication adherence will be monitored for 28 days, followed by an in-home post-test (all pre-test measures) during which the equipment is returned.

Inclusion criteria

• 45-90 years of age
• documented systolic or diastolic heart failure

Exclusion criteria

• History of neurological disorder
• moderate or severe head injury with greater than 10 min loss of consciousness
• Past or current history of severe psychiatric illness. Specifically, psychotic disorders (e.g. schizophrenia) and bipolar disorder. Potential study participants will not be excluded on the basis of managed depressive or anxiety disorder. These conditions are common in HF patients and their exclusion may limit generalizability of findings.
• 5 year past or current history of alcohol or drug abuse (defined by DSM-IV criteria)
• History of learning disorder or developmental disability (defined by DSM-IV criteria)
• Renal failure requiring dialysis
• Current home telemonitoring program to assist with HF self-management
• They do not have a land-line telephone
• Cardiac surgery < 3 months