Improving heart failure care and outcomes through behavioral economics

August 24, 2017 – Applying behavioral economic concepts and encouraging positive behaviors in heart failure patients may offer additional approaches to improving patient-centered outcomes, according to a new study by DCRI researchers.

An in-depth review by DCRI researchers published this week in Circulation, the official journal of the American Heart Association, highlights how behavioral economics concepts can help overcome barriers to change, encourage positive behaviors and offer novel approaches to improving patient outcomes for heart failure patients.

“The biggest challenge of living with heart failure is that it is something that must be dealt with around the clock, every single day, with no days off,” said the DCRI’s Adam DeVore, MD (pictured), the article’s first author. “When every meal you consume has the potential to make you sick, disciplined daily routines and consistently healthy behaviors become not just necessary, but crucial to a patient’s wellbeing and longevity.”

Heart failure affects 5.7 million American adults, costing the U.S. health system $30.7 billion annually, and is associated with high morbidity and mortality. The strong relationship between the disease and the patient’s daily lifestyle choices make it difficult to manage, yet these same challenges make it an ideal disease to target with well-designed “nudges.”

“Heart failure serves as a model prototype to explore the potential role of behavioral economics in managing chronic diseases,” DeVore said.

Their paper provides a brief explanation of core behavioral economics concepts that can predict and affect human behavior including various types of bias, loss aversion and anticipated regret, which apply to heart failure patients. It also provides guidelines on how to craft these concepts into tools, such as financial incentives and social networks that may improve the management of heart failure patients.

“While offering financial incentives or commitment contracts provides short-term gratification to reward behaviors consistent with a positive health outcome, social incentives combined with financial incentives have the potential to have a more powerful and longer-lasting effect on heart failure patients,” DeVore said.

Although there are various tools available for the effective management of heart failure, especially prescription medications, physicians struggle with being able to give those therapies to patients in an efficient way, where patients can remember to regularly take them on a timely basis.

To explore different ways to help patients with various aspects of self-care, DeVore and his colleagues are in the process of conducting the Care Optimization through Patient and Hospital Engagement Clinical Trial for Heart Failure (CONNECT-HF). CONNECT-HF is currently enrolling patients and will explore behavioral economics in relation to HF besides examining the impact of two mobile applications utilizing non-financial incentives and rituals.

“Our aim is to try and learn what different incentives we can use to try and help promote healthy behavior change,” DeVore said.

Acknowledging the work of co-author, Dan Ariely, MD, James B. Duke Professor of Psychology and Behavioral Economics at Duke University and his group, the Center for Advanced Hindsight, who also helped design and execute the CONNECT-HF trial, DeVore said that by incorporating behavioral knowledge into medical practice, low-cost, large-scale policy interventions can be developed to encourage positive and persistent behavioral change in heart failure patients.

In addition to DeVore and Ariely, other contributing authors included Leslie Chang, Bradi Granger, Zubin Eapen and Adrian Hernandez.

To learn more about the CONNECT-HF trial visit http://connectheartfailure.org.