Abstract 13356: Who Doesn't Respond to Motivational Interviewing for Heart Failure Self-care?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael A Stawnychy ◽  
Valentina Zeffiro ◽  
Paolo Iovino ◽  
Ercole Vellone ◽  
Barbara J Riegel
Keyword(s):  
Heart Failure ◽  
Sleep Quality ◽  
Motivational Interviewing ◽  
Sleep Disturbances ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Intervention Group ◽  
Secondary Analysis ◽  
Self Care ◽  
Significant Risk

Background: Motivational interviewing (MI) improves HF self-care yet fails to work for some patients. Lack of intervention response leaves clinicians and patients with fewer treatment options. Aim: Identify the characteristics of non-responders to MI in adults with HF. Methods: Secondary analysis of intervention group ( n =230) from MOTIVATE-HF trial. Study conducted in Italy to evaluate effectiveness of MI in improving HF self-care. Self-care maintenance measured with the validated Self-care of Heart Failure Index (SCHFI) v6.2 at baseline and 3 months from enrollment. Standardized scores range 0-100; changes > 7 pts from baseline are clinically significant. Participants dichotomized: MI non-responder (change in SCHFI < 7 pts) vs MI responder (change in SCHFI ≥ 7 pts). Logistic regression, adjusted for group differences (employment, income, living alone, HF etiology, baseline self-care, cognitive impairment, mutuality, medications, sleep quality, and HF health status), was used to estimate odds ratio with 95% confidence interval (OR [95% CI]) to identify determinants of non-response. Results: Half of the intervention group were non-responders to MI ( n =115) at 3 months. Non-responders were 72±13 years old and 53% male. Twice the number of non-responders were employed ( n =36 vs n =18, p <.005) and many reported ‘more than enough’ income (23% vs 13%, p <.046). They had more non-ischemic HF (79% vs 54%, p <.001), higher baseline self-care maintenance (48.8±19.2 vs 43.5±12.0, p <.009), and took fewer medications (6.1±3.0 vs 7.6±2.5, p <.009). Patients who responded to MI had worse HF quality of life ( p <.018), more sleep disturbances ( p <.042), and worse sleep quality ( p <.002). Significant risk factors for non-response were non-ischemic HF (2.606 [1.340-5.071], p <.005), fewer daily medications (0.829 [0.738-0.931], p <.002), and better baseline self-care maintenance (1.025 [1.001-1.050], p <.039). These variables explained 31% of HF self-care maintenance at 3 months (Nagelkerke R 2 =.309). Conclusion: MI may be less beneficial for patients with non-ischemic HF, lower medication burden, and relatively better self-care. Identifying characteristics of non-responders to MI in HF contributes to clinical decision making and personalized interventions.

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

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

Abstract P76: Effect of Patient Activation on Self-Management Behaviors in Heart Failure

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Martha Shively ◽  
Nancy Gardetto ◽  
Mary Kodiath ◽  
Ann Kelly ◽  
Tom Smith
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Repeated Measures ◽  
Intervention Group ◽  
Patient Activation ◽  
Self Care ◽  
Self Report ◽  
Self Management ◽  
Significant Group ◽  
Repeated Measures Design

Background Disease management and chronic care models have evidenced success with heart failure (HF) patients but have not fully explored patients' engagement/activation in self- care. Objective Determine efficacy of a patient activation intervention (Heart PACT Program) compared to usual care on activation and self-care management in HF. Methods This study was a 4-year, randomized, 2-group, repeated-measures design (baseline, 3 months, and 6 months). Following consent, 84 patients were stratified by activation level and randomly assigned to usual care (n = 41), or usual care plus the activation intervention (n = 43). The primary outcome variables were patient activation using the Patient Activation Measure (PAM) (Hibbard et al., 2005), and self-care using the Self-Care for Heart Failure Index (SCHFI) (Riegel et al., 2004) and the Medical Outcomes Study (MOS) Specific Adherence Scale. The intervention consisted of individual meetings and phone call follow-up over 6 months based on the patient's level of activation: stage 1 or 2 (low activation), stage 3 (medium), or stage 4 (high) as assessed by the patient's self-report PAM score and brief interview. The leaders collaborated with patients to improve activation and self-management of HF: adhering to medications; monitoring weight, blood pressure, and symptoms; and implementing health behavior goals. Findings Participants were primarily male (99%), Caucasian (77%), and classified as NYHA III (52%). The mean age was 66 years (SD 11). The majority (71%) of participants reported 3 or more comorbid conditions. The intervention group compared to the usual care group showed a significant increase in activation/PAM scores from baseline to 6 months (significant group by time interaction linear contrast, F=16.90, p=.02). Although the baseline MOS mean was lower in the intervention group, results revealed a significant group by time effect (F=9.16, p = .001) with the intervention group improving more over time. There were no significant group by time interactions for the SCHFI. Conclusion Patient activation can be improved through targeted intervention. The patient activation model has the potential to change approaches to tailored patient education for self-management in heart failure.

Abstract 13276: Dyad Gender and Relationship Quality Are Related to Heart Failure Self-care Maintenance

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael A Stawnychy ◽  
Ercole Vellone ◽  
Valentina Zeffiro ◽  
Barbara J Riegel
Keyword(s):  
Heart Failure ◽  
Relationship Quality ◽  
Reference Group ◽  
Secondary Analysis ◽  
Self Care ◽  
Italian Population ◽  
Dyadic Relationship ◽  
Health Maintenance ◽  
Gender Dyads ◽  
Mixed Gender

Background: Self-care, a process of health maintenance, monitoring and symptom management, improves morbidity and mortality in adults with HF. Caregivers are important in promoting patient self-care but little is known about the effect of relationship quality (RQ) on HF patient self-care, especially in same and mixed gender dyads. Aim: Quantify the contribution of dyadic gender and RQ on HF patient self-care maintenance. Methods: Secondary analysis of baseline data from a study of Italian adults with HF and their caregivers ( n =503). Dyads were enrolled to assess effectiveness of motivational interviewing on HF self-care maintenance measured with the Self-Care of Heart Failure Index v.6.2, validated in an Italian population. RQ was assessed with the Mutuality Scale, validated for HF patients and caregivers. Dyadic gender was categorized as Male-Male (M-M), Female-Male (Fpt-Mcg), Female-Female (F-F), and Male-Female (Mpt-Fcg; reference group). Univariate linear regression with backward elimination ( p <.05) was used to identify determinants of HF patient self-care maintenance. Results: The sample was 48% Mpt-Fcg, 27% F-F, 15% Fpt-Mcg, 10% M-M. Mpt-Fcg dyad patients were married (86%); with older (59±15 years), less educated (46% secondary or lower) spousal caregivers (66%). More F-F vs M-M patients lived alone (32% vs 4%). Determinants of better patient self-care were: living alone, receiving assistance for HF, better mental quality of life, patient and caregiver employment, caregiver married status, higher caregiver perceived social support, and more months caring for the patient. Dyad gender, RQ, and these covariates explained 23% of variance in patient self-care maintenance. Dyad gender independently contributed to self-care, but only for same gender dyads. Being in a M-M dyad was associated with higher patient self-care (ß=.52, p <.026). Better caregiver perception of RQ in both M-M and F-F dyads was associated with lower patient self-care (M-M: ß=-.97, p <.001; F-F: ß=-.55, p <.026). There were no significant interactions for patient RQ or mixed gender dyads. Conclusion: Dyadic relationship quality appears to be important for self-care, particularly in M-M dyads and should to be considered when working with HF patients and their caregivers.

scholarly journals Association between sleep quality and self-care in adults with heart failure: A systematic review

2020 ◽  
pp. 147451512094136 ◽  
Author(s):  
Valentina Spedale ◽  
Michela Luciani ◽  
Alessandro Attanasio ◽  
Stefania Di Mauro ◽  
Rosaria Alvaro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Medication Adherence ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Self Care ◽  
The Other ◽  
Heart Failure Patients ◽  
Meta Analyses

Background: Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking. Aims: This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute’s Critical Appraisal Tools. Results: Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence. Conclusions: Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism.

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

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 &lt; MAP &lt;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 &gt;100 mmHg, with 22% in the CG versus 16% in the IG having MAP &gt;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

The influence of gender and race on heart failure self-care

2019 ◽  
pp. 174239531984316
Author(s):  
Lucinda J Graven ◽  
Laurie Abbott ◽  
Sabrina L Dickey ◽  
Glenna Schluck
Keyword(s):  
Heart Failure ◽  
Racial Differences ◽  
Care Management ◽  
Secondary Analysis ◽  
Self Care ◽  
Female Gender ◽  
Maintenance Management ◽  
Gender And Race ◽  
Care Outcomes ◽  
Univariate Analyses

Objectives To explore gender and racial differences in heart failure (HF) self-care processes and examine whether gender and race predict HF self-care. Methods A secondary analysis of baseline data ( n = 107) from a longitudinal HF study (54.2% males; 56% non-Caucasians) was conducted. The self-care of heart failure index was used to measure self-care maintenance, management, and confidence. Descriptive statistics and univariate analyses examined gender and racial differences in HF self-care outcomes. Multiple linear regression examined whether gender and race predicted HF self-care maintenance, management, and confidence. Results Univariate analyses indicated that Caucasians reported significantly better self-care maintenance ( p = 0.042), while non-Caucasians reported significantly better self-care management ( p = 0.003). Males had significantly higher self-care confidence scores versus women ( p = 0.017). Multiple regression analysis indicated Caucasian race predicted significantly worse self-care management (β = −11.188; p = 0.006) versus non-Caucasian, while male gender predicted significantly higher self-care confidence scores (β = 7.592; p = 0.010) versus female gender. Gender nor race significantly predicted self-care maintenance. Discussion Although gender and race may influence HF self-care, other factors may be more important. More research is needed to identify individual factors that contribute to HF self-care to improve education and intervention.

scholarly journals Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors

2020 ◽  
Vol 19 (5) ◽  
pp. 421-432 ◽  
Author(s):  
Maria Liljeroos ◽  
Naoko P Kato ◽  
Martje HL van der Wal ◽  
Maaike Brons ◽  
Marie Louise Luttik ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Perceived Control ◽  
Secondary Analysis ◽  
Self Care ◽  
Prevalence Of Depression ◽  
Threshold Score ◽  
Beneficial Impact ◽  
Underlying Mechanisms ◽  
The Impact

Background: Patients’ self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied. Aims: (1) To describe the trajectory of patients’ self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour. Methods: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour. Results: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05). Conclusion: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.

scholarly journals Mechanisms of change in self-care in adults with heart failure receiving a tailored, motivational interviewing intervention

2017 ◽  
Vol 100 (2) ◽  
pp. 283-288 ◽  
Author(s):  
Barbara Riegel ◽  
Victoria Vaughan Dickson ◽  
Lydia Elena Garcia ◽  
Ruth Masterson Creber ◽  
Megan Streur
Keyword(s):  
Heart Failure ◽  
Motivational Interviewing ◽  
Self Care ◽  
Mechanisms Of Change

scholarly journals A Mobile Phone–Based Telemonitoring Program for Heart Failure Patients After an Incidence of Acute Decompensation (Medly-AID): Protocol for a Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Emily Seto ◽  
Heather Ross ◽  
Alana Tibbles ◽  
Steven Wong ◽  
Patrick Ware ◽  
...  
Keyword(s):  
Heart Failure ◽  
Controlled Trial ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Self Care ◽  
Standard Of Care ◽  
Randomized Controlled ◽  
Acute Decompensation ◽  
The Impact

BACKGROUND Patients with heart failure (HF) are at the highest risk for hospital readmissions during the first few weeks after discharge when patients are transitioning from hospital to home. Telemonitoring (TM) for HF management has been found to reduce mortality risk and hospital readmissions if implemented appropriately; however, the impact of TM targeted for patients recently discharged from hospital, for whom TM might have the biggest benefit, is still unknown. Medly, a mobile phone–based TM system that is currently being used as a standard of care for HF at a large Canadian hospital, may be an effective tool for the management of HF in patients recently discharged from hospital. OBJECTIVE The objective of the <italic>Medly-After an Incidence of acute Decompensation</italic> (Medly-AID) trial is to determine the effect of Medly on the self-care and quality of life of patients with HF who have been recently discharged from hospital after an HF-related decompensation. METHODS A multisite multimethod randomized controlled trial (RCT) will be conducted at 2 academic hospitals and at least one community hospital to evaluate the impact of Medly-enabled HF management on the outcomes of patients with HF who had been hospitalized for HF-related decompensation and discharged during the 2 weeks before recruitment. The trial will include 144 participants with HF (74 in each control and intervention groups). Control patients will receive standard of care, whereas patients in the intervention group will receive standard of care and Medly. Specifically, patients in the intervention group will record daily weight, blood pressure, and heart rate and answer symptom-related questions via the Medly app. Medly will generate automated patient self-care messages such as to adjust diuretic medications, based on the rules-based algorithm personalized to the individual patient, and send real-time alerts to their health care providers as necessary. All patients will be followed for 3 months. Primary outcome measures are self-care and quality of life as measured through the validated questionnaires Self-Care of Heart Failure Index, EQ-5D-5L, and the Kansas City Cardiomyopathy Questionnaire-12. Secondary outcome measures for this study include cost of health care services used and health outcomes. RESULTS Patient recruitment began in November 2018 at the Sunnybrook Health Sciences Centre, with a total of 35 participants recruited by July 30, 2019 (17 in the intervention group and 18 in the control group). The final analysis is expected to occur in the fall of 2020. CONCLUSIONS This RCT will be the first to assess the effectiveness of the Medly TM system for use following discharge from hospital after a HF-related decompensation. CLINICALTRIAL ClinicalTrials.gov NCT03358303; https://clinicaltrials.gov/ct2/show/NCT03358303

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