Motivational Interviewing as a new Approach to Improve Outcome Through Self-care Behavioral Changes in Advanced Heart Failure Patient: a case report
Abstract Background A lack of adherence and inadequate self-care behaviors are common reasons for recurrent hospitalizations among patients with heart failure (HF). Although patients recognize the importance of HF self-care, it is sometimes difficult to correct their behavioral patterns. Motivational interviewing is a communication technique to resolve ambivalence toward changing behavior, and it has been widely used to promote behavioral changes and improve outcomes in various chronic diseases. We described a case of advanced HF with reduced ejection fraction in which motivational interviewing lead to stabilize the patient’s condition. Case summary A 33-year-old man was diagnosed with dilated cardiomyopathy (DCM) who experienced repeated episodes of HF requiring hospitalization despite optimal guideline-based HF treatment. Transthoracic echocardiography disclosed a severely reduced LV contraction (LVEF 18%) and CPET disclosed markedly reduced functional capacity and increased ventilatory response (peak VO2 of 10.7 mL/min/kg, predicted peak VO2 of 34.7% and VE/VCO2 slope of 35.2). In this case, poor adherence to self-care such as excessive fluid intake and excessive daily activities after hospital discharge was the main cause of recurrent hospitalization for HF. Despite repeated patient education to correct his diet and lifestyle, he could not change his lifestyle behavior. However, motivational interviewing dramatically helped stabilize the patient’s condition and prevent HF re-hospitalization. Discussion In general, patients with advanced HF and reduced ejection fraction despite optimal medical therapy should be evaluated to assess their eligibility of cardiac transplantation or palliative care. Motivational interviewing might represent a new therapeutic approach for stabilizing and preventing HF through self-care behavioral changes, even in patients with advanced HF and severely reduced ejection fraction.
