Peer-to-peer support benefits patients, but the model needs to change rapidly to keep up with treatment innovations.   

Value of peer support 

Peer-to-peer support programs provide counseling and emotional support to individuals and their families at the hospital bedside and after discharge through in-person and online support group activities and via educational materials and social events. A substantial and growing body of evidence indicates that such programs can play an important role as individuals with heart disease recover from surgeries and procedures. Mended Hearts was founded in 1951 with the mission of providing such peer-to-peer support to inspire hope and improve quality of life for cardiac patients and their families. 

The value of such peer support was highlighted in a 2017 American Journal of Managed Care review article that examined eight research efforts and case studies, including the intensive patient education program at Memorial Regional Hospital’s Cardiac and Vascular Institute in Hollywood, Fla. (23[Suppl 3]:S54-7). The program, which is offered in partnership with the local Mended Hearts chapter, includes a mandatory pre-discharge class as well as extensive, ongoing post-discharge peer support. The hospital’s leaders believe that this program has contributed to the high rankings the cardiac program has received from Consumer Reports and other organizations. 

By letting patients know that they are not alone, Mended Hearts and other peer support programs can lead to patients taking their medications and adopting healthier practices. Qualitative and quantitative data suggest that this, in turn, can contribute to higher patient satisfaction, improved outcomes, reduced readmissions and potentially lower healthcare costs. 

In 2015, an analysis of a small, nonprojectable sample of Centers for Medicare & Medicaid Services (CMS) data found that hospitals with Mended Hearts programs had lower read-mission rates for heart failure than the national average. According to a companion survey, patients who had received peer support reported high degrees of satisfaction with their hospital stay and overall experience.  

Evolving models 

In partnership with over 450 U.S. hospitals, Mended Hearts volunteers conduct more than 200,000 bedside visits and thousands of group events annually. The support program was originally designed with longer-stay surgical patients in mind, and this population continues to be central to the Mended Hearts mission. However, as healthcare changes, peer-support programs must change and adapt as well. 

In particular, less invasive treatments, such as percutaneous coronary interventions and transcatheter aortic valve replacement (TAVR), require a fresh approach. Though TAVR patients often are older and sicker than other surgical patients, they generally have shorter hospital stays. Thus, their medical condition frequently precludes much pre-procedure peer support and the window for post-procedure, pre-discharge peer support tends to be quite short. Recognizing that peer-to-peer support is no less vital for TAVR vs. other patients—and arguably may be more important—Mended Hearts committed to developing a model that is different from what has worked in the past but just as effective. 

In 2017, after consultation with all of cardiology’s stakeholders, Mended Hearts introduced an updated model for supporting TAVR patients, with the following components: 

• Specially trained volunteers who themselves have undergone TAVR form the core of the program. All volunteers participate in a rigorous certification program as well as appropriate training in the chapter’s host hospital. 
• In-hospital support, offered whenever circumstances allow. 
• Ongoing support by phone and, where possible, by email. Telephone contact is the core of the Mended Hearts TAVR support program because hospital stays tend to be relatively brief. 
• Trustworthy print, online and video educational materials, reviewed by the Mended Hearts Medical Advisory Council. 
• Updated discussion guides and expert presentations for support group meetings, augmented with webinars, to promote discussion and serve as on-demand tools. 
• Member newsletter and Heartbeat magazine, featuring content about new treatments such as TAVR.

Just as peer-to-peer support has been valuable for decades of surgical patients, such programs will be important for patients undergoing TAVR and other less invasive therapies. Mended Hearts looks forward to sharing the results of its new peer support model with the cardiovascular community.  

Donnette Smith is a heart patient and the president of Mended Hearts. Norm Linsky is the group’s executive director. They thank Edwards Lifesciences for support of the Mended Hearts TAVR Outreach and Support Program.