A Multi-Component Remote Care Intervention for Rural Patients Living with Heart Failure

Heart failure (HF), a condition associated with increased hospitalizations, cost, and mortality, is a large and growing contributor to the mortality gap between rural and urban populations in the United States. Individuals living in rural communities face significantly higher mortality from HF than those in urban communities. Without the development of effective HF management strategies tailored to rural populations, these individuals will continue to experience higher rates of morbidity and mortality. Rural-dwelling patients with HF face numerous obstacles to receiving appropriate outpatient care. Thus, there is a critical need to identify feasible, cost-effective, and scalable delivery strategies for HF care in rural areas. To this end, we plan to: 1) elicit feedback on remote intervention strategies to inform implementation of HF care within rural communities; 2) conduct a pilot 2³ factorial trial to examine the feasibility and acceptability of three intervention strategies for delivering HF care to rural-dwelling participants; and 3) characterize contextual factors relevant to the delivery and implementation of these remote care strategies. Our central hypothesis is that these intervention strategies (video-based visits, remote patient monitoring, and remote self-care education) will be feasible and acceptable, and that combinations of these components will show preliminary effectiveness in caring for rural-dwelling individuals with HF. Through this proposal and the Multiphase Optimization Strategy (MOST) framework, we will identify an optimal combination of intervention components to facilitate remote HF care, and combine with stakeholder input, we will develop a larger randomized trial. Additionally, the PI will use this proposal to focus a career on rural health as a physician-scientist through the following training aims: 1) Gain experience with qualitative research methods; 2) Develop skills in innovative trial design (factorial trials) and implementation frameworks; and 3) Advance expertise in intervention development for rural populations. This training plan will be supported by a multidisciplinary mentorship and advisory team to guide the successful completion of the research and training aims.