Effectiveness of motivational interviewing on health-service use and mortality: a secondary outcome analysis of the MOTIVATE-HF trial

Aims Intense health-care service use and high mortality are common in heart failure (HF) patients. This secondary analysis of the MOTIVATE-HF trial investigates the effectiveness of motivational interviewing (MI) in reducing health-care service use (e.g. emergency service use and hospitalizations) and all-cause mortality.Methods and results This study used a randomized controlled trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (control group). Data were collected at baseline and at 3, 6, 9, and 12 months. Face-to-face MI plus three telephone calls were performed in Arms 1 and 2. The sample consisted of 510 patient (median age 74 years, 58% male patients) and caregiver dyads (median age 55 years, 75% female patients). At 12 months, 16.1%, 17%, and 11.2% of patients used health-care services at least once in Arms 1, 2, and 3, respectively, without significant difference. At 3 months, 1.9%, 0.6%, and 5.1% of patients died in Arms 1, 2, and 3, respectively. Mortality was lower in Arm 2 vs. Arm 3 at 3 months [hazard ratio (HR) = 0.112, 95% CI: 0.014-0.882, P = 0.04]; no difference was found at subsequent follow-ups. Mortality was lower in Arm 1 vs. Arm 3 at 3 months but did not reach statistical significance (HR = 0.38, 95% CI: 0.104-1.414, P = 0.15).Conclusion This study suggests that MI reduces mortality in patients with HF if caregivers are included in the intervention. Further studies with a stronger intervention and longer follow-up are needed to clarify the benefits of MI on health-care service use and mortality

Anti-hcv treatment for opiate addicts: Clinical and immunological issues

HCV infection is a major health concern worldwide, and the main cause of liver failure. A total of 180 million people is infected with HCV, and is the most frequent infection among drug addicts, with a frequency in the range of 50-90% in Europe. Chronic persistence of HCV infection and its progression are linked to a variety of factors, including the current exposure to opiate drugs themselves, because of their direct impact on the immune system. Opiates are believed to be immunosuppressant as a rule, but recent evidence has shown that opiates differ as regards their immunological properties. Methadone, which is commonly used for opiate addiction treatment, is a synthetic compound acting mainly on µ-opioid receptors; methadone happens to be free of immunosuppressant properties, at least when its slow-acting formulation is administered continuously. It is likely that such an action is achieved by its impact on suprarenal activity, as it restores the suprarenal abnormalities of heroin addicts, and the long-lasting tonic activation of µ-receptors in the central nervous system and activates a range of immune cells. The enrolment of methadone-maintained addicts in HCV treatment programmes may help to increase the effectiveness of HCV treatment by systematically impeding the transmission of HCV infection via the reservoir of drug addicts