Predictors of Better Self-Care in Patients with Heart Failure after Six Months of Follow-Up Home Visits

This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P≤0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P<0.001), had more years of schooling (P=0.016), and had more comorbidities (P=0.008). Having received the intervention (P<0.001) and having a greater number of comorbidities (P=0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care.

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An improvement in self-care behaviour in heart failure patients lead to better management of hypertension

European Heart Journal ◽

10.1093/ehjci/ehaa946.1127 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D.S Sahlin ◽

S Gerward

Keyword(s):

Heart Failure ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Controlled Trial ◽

Intervention Group ◽

Self Care ◽

Control Group ◽

Chi Square ◽

Home Based ◽

Number Of Patients

Abstract Background A common heart failure (HF) aetiology is hypertension (HTN), second only to ischemic heart disease and with a prevalence in the HF community of between 62% and 84%, depending on sex and ejection-fraction. Undertreated HTN leads to worse prognosis and resistant HTN is defined as blood pressure (BP) exceeding 140/90 mmHg, in spite of pharmacological treatment. Since one constituent of self-care behaviour is treatment adherence, we wished to study whether patients exposed to a digital intervention shown to improve self-care behaviour, would also display improved BP control. Methods SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne in southern Sweden, where patients in the intervention group (IG) were equipped with a digital home-based tool, designed to enhance self-care behaviour for HF-patients and the control group (CG) were subject to standard care. BP data was registered at baseline and after eight months of intervention and self-care behaviour was measured using the European Heart Failure Self-care Behaviour Scale (EHFScB). We used a Chi-square test to analyse whether there was an inter-group difference of prevalence of resistant HTN or a mean arterial pressure (MAP) outside the recommended range of 60 mmHg < MAP <100 mmHg. Results Out of the 118 patients included in the original analysis, 92 (78%) had complete BP measurements. At baseline there was no difference in self-care behaviour between the groups, with CG: 25 [17.5; 32] and IG: 24.5 [18; 30], p=0.61, and 28% of the CG patients and 24% of the IG population displayed resistant HTN, p=0.73. After eight months of intervention the IG had 21% (or 4.5 points) better self-care behaviour compared to the CG, p=0.014, and the fraction of patients with resistant HTN was 30% for the CG and 11% for the IG, p=0.027. There was also a significant effect on the fraction of patients having a MAP >100 mmHg, with 22% in the CG versus 16% in the IG having MAP >100 mmHg at baseline (p=0.39) and 19% in the CG versus 0% in the IG at follow-up (p=0.002). Conclusions There was a significant improvement in self-care behaviour and also a significant reduction in the number of patients with resistant hypertension and elevated mean arterial pressure after eight months of intervention. Funding Acknowledgement Type of funding source: None

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Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117727740 ◽

2017 ◽

Vol 17 (2) ◽

pp. 178-185 ◽

Cited By ~ 20

Author(s):

M Boyde ◽

R Peters ◽

N New ◽

R Hwang ◽

T Ha ◽

...

Keyword(s):

Heart Failure ◽

Randomised Controlled Trial ◽

Educational Intervention ◽

Hospital Readmission ◽

Controlled Trial ◽

Intervention Group ◽

Self Care ◽

Control Group ◽

Patients With Heart Failure ◽

Randomised Controlled

Background: A variety of educational interventions have been implemented to assist patients with heart failure to maintain their own health, develop self-care behaviours and decrease readmissions. Aims: The purpose of this study was to determine the effectiveness of a multimedia educational intervention for patients with heart failure in reducing unplanned hospital readmissions. Methods: The study, a randomised controlled trial in a large tertiary referral hospital in Australia, recruited 200 patients. Patients diagnosed with heart failure were randomly allocated 1:1 to usual education or a multimedia educational intervention. The multimedia approach began with an individual needs assessment to develop an educational plan. The educational intervention included viewing a DVD, and verbal discussion supported by a written manual with a teach-back evaluation strategy. The primary outcome was all-cause unplanned hospital readmission at 28 days, three months and 12 months post-recruitment. The secondary outcomes were changes in knowledge and self-care behaviours at three months and 12 months post-recruitment. Results: At 12 months, data on 171 participants were analysed. There were 24 participants who had an unplanned hospital readmission in the intervention group compared to 44 participants in the control group ( p=0.005). The self-care educational intervention reduced the risk of readmission at 12 months by 30% (relative risk: 0.703; 95% confidence interval: 0.548–0.903). Conclusion: A targeted multimedia educational intervention can be effective in reducing all-cause unplanned readmissions for people with heart failure.

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A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

10.2196/preprints.26185 ◽

2020 ◽

Author(s):

Michael P. Dorsch ◽

Karen B. Farris ◽

Brigid E. Rowell ◽

Scott L. Hummel ◽

Todd M. Koelling

Keyword(s):

Heart Failure ◽

Mobile Application ◽

Controlled Trial ◽

Intervention Group ◽

Self Care ◽

Self Management ◽

Control Group ◽

Patient Centered ◽

Self Monitoring ◽

Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

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Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled Trial

Nursing Reports ◽

10.3390/nursrep11020040 ◽

2021 ◽

Vol 11 (2) ◽

pp. 418-429

Author(s):

Joana Pereira Sousa ◽

Hugo Neves ◽

Miguel Pais-Vieira

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Care Management ◽

Controlled Trial ◽

Self Care ◽

Fluid Restriction ◽

Symptom Recognition ◽

Patients With Heart Failure ◽

Randomised Controlled

Patients with heart failure have difficulty in self-care management, as daily monitoring and recognition of symptoms do not readily trigger an action to avoid hospital admissions. The purpose of this study was to understand the impact of a nurse-led complex intervention on symptom recognition and fluid restriction. A latent growth model was designed to estimate the longitudinal effect of a nursing-led complex intervention on self-care management and quality-of-life changes in patients with heart failure and assessed by a pilot study performed on sixty-three patients (33 control, 30 intervention). Patients in the control group had a higher risk of hospitalisation (IRR 11.36; p < 0.001) and emergency admission (IRR 4.24; p < 0.001) at three-months follow-up. Analysis of the time scores demonstrated that the intervention group had a clear improvement in self-care behaviours (βSlope. Assignment_group = −0.881; p < 0.001) and in the quality of life (βSlope. Assignment_group = 1.739; p < 0.001). This study supports that a nurse-led programme on symptom recognition and fluid restriction can positively impact self-care behaviours and quality of life in patients with heart failure. This randomised controlled trial was retrospectively registered (NCT04892004).

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Psychosocial determinants of self-care behavior in outpatients with heart failure: A test of Penderʼs health promotion model

10.32592/ircmj.2020.22.12.141 ◽

2020 ◽

Keyword(s):

Heart Failure ◽

Health Promotion ◽

Conceptual Model ◽

Self Care ◽

Perceived Benefits ◽

Cross Sectional ◽

Health Promotion Model ◽

Psychosocial Determinants ◽

Patients With Heart Failure ◽

Care Behavior

Background: Patients with heart failure need to be engaged in adequate cardiac self-care behaviors helping to prevent the development of the disease and ameliorate their health status. However, the conceptual model of the present study has not been tested in previous studies among patients with heart failure. Objectives: The present study aimed to investigate the psychosocial determinants based on Pender’s health promotion model (HPM) affecting self-care behavior among outpatients suffering from heart failure. Methods: In this cross-sectional study, a total of 200 patients suffering from heart failure were selected from the outpatient clinics of Tabriz, Iran, using convenience sampling and assessed for self-self-care behaviors and major concepts of HPM via self-administered questionnaires. Path analysis was used in order to analyze the conceptual model Results: The present hypothetical model showed a good fit. Perceived benefits and activity-related effects directly affected self-care behaviors. Bootstrapping mediation analyses indicated that perceived self-efficacy, perceived barriers, perceived benefits, and activity-related effects indirectly affected self-care behaviors through commitment to action. Conclusions: The commitment to action can help to promote self-care behaviors among the subjects suffering from heart failure. The interventions should take the role of predictive variables of this study and commitment to action into account in these patients.

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From randomised controlled trial to real world implementation of a novel home-based heart failure tool: pooled and comparative analyses of two clinical controlled trials

Open Heart ◽

10.1136/openhrt-2018-000954 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000954 ◽

Cited By ~ 1

Author(s):

Ann Hovland-Tånneryd ◽

Michael Melin ◽

Ewa Hägglund ◽

Inger Hagerman ◽

Hans E Persson

Keyword(s):

Heart Failure ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Self Care ◽

Control Group ◽

Data Set ◽

Pooled Data ◽

Home Based ◽

Randomised Controlled ◽

Hospital Days

ObjectivesA home-based tool for heart failure (HF) patients, was evaluated in a specialist setting as a randomised controlled trial (RCT) and also in a validation cohort in a primary care setting in a clinical controlled trial (CCT). The tool provides education, symptom monitoring and titration of diuretics. The aim of this study was thus to extend validity of the previous RCT findings in order to describe applicability of the tool in clinical practice.MethodsData from both trials were analysed separately, as well as a pooled data set (n=172). Data were analysed with respect to HF related in-hospital days, self-care behaviour and system adherence, during a 6-month intervention. The analysis of in-hospital days for the pooled data was adjusted for baseline differences between the two study cohorts, relating to disease state.ResultsIn the RCT (n=72) the intervention group (IG) consisted of 32 patients and the control group (CG) of 40 patients. The risk ratio (RR) for in-hospital days was RR: 0.72, 95% CI 0.61 to 0.84, p<0.05 in favour of the IG. In the CCT (n=100) both the IG and the CG consisted of 50 patients and the IG had fewer in-hospitals days, comparable to the RCT findings with RR: 0.67; 95% CI 0.45 to 0.99; p<0.05. For the pooled data set made up of 172 patients, the groups were well balanced but with a higher prevalence of hypertension in the CG. The RR relating to in-hospital days for the pooled data set was 0.71; 95% CI 0.61 to 0.82; p<0.05 in favour of the IG. There was a statistically significant improvement in self-care by 27% and the median system adherence was 94%.ConclusionsThese analyses suggest that the evaluated tool might reduce HF related in-hospital days in the general HF population, which adds to the external validity of previous findings.Clinical Trial RegistrationNCT03655496.

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A Culturally Appropriate Educational Intervention Can Improve Self-Care in Hispanic Patients With Heart Failure: A Pilot Randomized Controlled Trial

Cardiology Research ◽

10.14740/cr346w ◽

2014 ◽

Author(s):

Howie-Esquivel

Keyword(s):

Heart Failure ◽

Randomized Controlled Trial ◽

Educational Intervention ◽

Controlled Trial ◽

Self Care ◽

Culturally Appropriate ◽

Randomized Controlled ◽

Patients With Heart Failure ◽

Hispanic Patients ◽

Pilot Randomized Controlled Trial

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The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure. A secondary analysis of a randomised controlled trial

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2019.103454 ◽

2019 ◽

pp. 103454 ◽

Cited By ~ 1

Author(s):

Peter Johansson ◽

Tiny Jaarsma ◽

Gerhard Andersson ◽

Johan Lundgren

Keyword(s):

Heart Failure ◽

Depressive Symptoms ◽

Randomised Controlled Trial ◽

Behavioral Therapy ◽

Controlled Trial ◽

Secondary Analysis ◽

Patients With Heart Failure ◽

Randomised Controlled ◽

The Impact ◽

Care Behavior

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Evaluation of self care behaviours, medication and dietary compliance of patients with heart failure

New Trends and Issues Proceedings on Humanities and Social Sciences ◽

10.18844/prosoc.v4i2.2734 ◽

2017 ◽

Vol 4 (2) ◽

pp. 86-93

Author(s):

Sengul Akdeniz

Keyword(s):

Heart Failure ◽

Medication Compliance ◽

Personal Information ◽

Self Care ◽

Study Data ◽

Cross Sectional ◽

Dietary Compliance ◽

Patients With Heart Failure ◽

Moderate Relationship ◽

Care Behavior

In this study, it was aimed to evaluate the self-care behaviors, dietary and medication compliance of patients with heart failure.The study was conducted as a cross-sectional sampling study between April and August 2016. After identifying the clinical diagnosis and treatment, 120 patients who were diagnosed with HF were included in the study. Data were obtained by using personal information form, Turkish versions of the European Heart Failure Self-care Behavior Scale (EHFScBS), Beliefs about Medication Compliance Scale and Beliefs about Dietary Compliance Scale for patients with HF. The mean score on EHFSc BS was found to be 31.20± 8.05. Benefit and barrier subscale mean scores were found to be 26.11 ± 4.23 and 13.09 ± 3.5 for dietary compliance and 20.44 ± 2.7 and 22.36 ± 3.8 for medication compliance, respectively. According to the results of the study ıt was found that there was a moderate relationship between self-care behaviors and dietary compliance (r=0,538,p<0,05) benefits and medication compliance (r=0,420, p<0,05 ) benefits. Keywords: The European Heart Failure self care scale; medication compliance; dietary compliance; heart failure.

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