Abstract 16296: Heart Failure-Smart Life: Effects of a Mobile-based Education and Self-management Program for Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jeong-Ah Ahn ◽  
Eui-Young Choi ◽  
Jin-Sun Park

Introduction: It is considered an important strategy to support heart failure (HF) patients for lifetime self-management. However, some programs for HF patients made them difficult to revisit the hospital or due to economic burden. Therefore, a practical alternative to a comprehensive and user-friendly self-management program for HF patients is needed. Purpose: The aim of this study was to develop a mobile App program for HF patients, and to identify the impact of the program on patients with HF. Methods: We developed a mobile App program, named “HF-Smart Life”. This App installed the configurations and functions of educational materials using pictures and animations, daily health (blood pressure and body weight) check-up diary, Q & A, and 1:1 chat considering user’s convenience. Regarding the experimental study, we employed a quasi-experimental design to evaluate the effects of the program in 74 patients with HF. The experimental group participated to use the mobile App program, including education, feedbacks on self-management, and monitoring in their daily life, for 3 months. Results: Participants of the program (n=36) exhibited significantly improved NYHA functional class and cardiac diastolic function (E/Ea ratio measured by echocardiogram) than the control group (n=38) after 3 months. The mean NYHA function class of the experimental group changed from 2.14 to 1.82, and that of the control group changed from 2.66 to 2.38 (F=9.260, p=.003). Also, the mean E/Ea ratio decreased from 12.24 to 11.35 in the experimental group, whereas that of the control group increased from 14.70 to 16.42 (F=5,280, p=.024). However, there was no significant difference between the groups with cardiac systolic function (left ventricular ejection fraction measured by echocardiogram) and quality of life. Conclusions: This mobile App program showed effectively improvements in HF patients' symptom (functional) class and cardiac diastolic function. Future study is needed to investigate the long-term effects of the mobile-based education and self-management program in HF population. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2017R1C1B1007090 & 2019R1F1A1063148).

2021 ◽  
pp. 109980042110618
Author(s):  
Mei-Chen Lee ◽  
Shu-Fang Vivienne Wu ◽  
Kuo-Cheng Lu ◽  
Wen-Hug Wang ◽  
Yen-Yen Chen ◽  
...  

This longitudinal study with a randomized controlled trial evaluated the long-term effectiveness of the patient-centered self-management intervention program on the control of blood pressure and renal function, as well as the quality of life of patients with hypertensive nephropathy. The control group ( n = 38) received usual care while the experimental group ( n = 38) participated in a patient-centered self-management program. After the pre-test, the intervention was performed with the experimental group once a week for a total of 4 weeks. Then, the post-test was performed 1, 3, and 6 months later. A questionnaire was used to collect the demographic data and disease characteristics, laboratory data, and quality of life scale. This study tracked three time points (i.e., 1, 3, and 6 months) after the intervention and found that the experimental group achieved significant results in controlling systolic blood pressure ( p < 0.001), diastolic blood pressure ( p = 0.007), and eGFR ( p = 0.013). Significant results were achieved in the overall quality of life ( p < 0.001) and the quality of life in the physical (PHC; p < 0.001) and mental health components (MHC; p < 0.001). Furthermore, the effects in the experimental group lasted for as long as 6 months and were better than those in the control group. Moreover, this program can provide nursing staff with a reference different from traditional health education methods.


2021 ◽  
Vol 46 (3) ◽  
pp. 177-189
Author(s):  
Tingying Hu ◽  
Haodengjie Xiong ◽  
Huilin Zhou ◽  
Yujie Song ◽  
Zhilin Zhang ◽  
...  

Objective: To investigate the effect of acupoint meridian therapeutic exercise on cardiopulmonary function in patients with chronic heart failure (CHF).<br/> Methods: One hundred patients diagnosed with CHF at the Department of Cardiology from June 2019 to October 2019 were enrolled. One hundred patients were randomly divided into an experimental group (n = 50) and a control group (n = 50) according to the treatment they received. The experimental group received conventional treatment combined with acupoint meridian therapeutic exercise for three months. The patients in the two groups were compared in terms of their results on the six-minute walk test and their cardiac function grade, plasma brain natriuretic peptide (BNP) concentration, left ventricular ejection fraction (LVEF), and quality of life.<br/> Results: A statistically significant increase in six-minute walking distance was observed in the experimental group compared with the control group. Cardiac function and plasma BNP concentration decreased and LVEF and quality of life increased.<br/> Conclusion: Acupoint meridian therapeutic exercise improves exercise tolerance, cardiopulmonary function, and quality of life in patients with CHF.


2021 ◽  
pp. 019394592199491
Author(s):  
Yeojin Kim ◽  
Hyejin Lee ◽  
Ji Min Seo

This study identified the effects of an integrated diabetes self-management program using smartphone application (app), based on the Information-Motivation-Behavioral skills (IMB) model. A randomized comparison, using a pre-and post-test design, was conducted with 32 participants in the experimental group and 36 in the control group. The integrated diabetes self-management program consisted of face-to-face educational sessions, a diabetes self-management smartphone app, and phone counseling. In the experimental group, diabetes self-management knowledge (Z=-2.70, p=.007), social motivation (Z=-1.97, p=.048), and behavior (t=3.22, p=.002) improved, with their hemoglobin A1c (Z=-4.83, p<.001) decreasing compared to the control group. At the post-test, the experimental group’s fasting blood sugar level (t=2.79, p=.009), total calorie intake (t=3.94, p=.001), carbohydrate intake (t=5.69, p<.001), and fat intake (t=2.54, p=.021) decreased compared to the pre-test. An integrated diabetes self-management program using smartphone app, based on the IMB model, should be utilized as a nursing intervention.


2017 ◽  
Vol 16 (1) ◽  
pp. 9-17
Author(s):  
Dayan HISNI ◽  
Tippamas CHINNAWONG ◽  
Ploenpit THANIWATTANANON

Elderly people with poorly controlled type 2 DM often develop cardiovascular disease (CVD) as a major complication. Prevention can be managed by the action of preventing cardiovascular complication behaviors (PCCB) which consist of a DM and healthy heart diet, physical exercise, taking medication regularly, and ceasing smoking. The cardiovascular self-management support program (CSSP) facilitates successful and improved PCCB and clinical outcomes in the elderly with poorly controlled type 2 DM. A quasi-experimental study was conducted to find out the effectiveness of CSSP on PCCB and clinical outcomes in elderly with poorly controlled type 2 DM. Fifty-nine elders with poorly controlled type 2 DM were randomly recruited and divided into an experimental and a control group. Of these, 30 participants in the experimental group received the CSSP and the usual care whereas the control group only received the usual care. PCCB was measured by the prevention of cardiovascular complication behaviors questionnaire (PCCBQ), while clinical outcomes were measured by clinical devices provided by the Public Health Center. An independent t-test was conducted to determine the effect of the program between groups and a paired t-test was used to report the effect of the program within the group. The results showed that the mean score of the PCCB in the experimental group was significantly higher than those in the control group after participating in the program (p < .05) and improved the mean scores of the clinical outcomes except for the diastolic blood pressure (p > .05). The CSSP in this study clearly indicates positive effects on improving the PCCB and some clinical outcomes in the elderly with poorly controlled type 2 DM.


2018 ◽  
Vol 69 (6) ◽  
pp. 1435-1440
Author(s):  
Mirela Zaharie ◽  
Doina Carstea ◽  
Costin Teodor Streba ◽  
Paul Mitrut ◽  
Adina Dorina Glodeanu ◽  
...  

Heart failure (HF) and renal dysfunction are frequent associated in the same patient. The purpose of our study was to assess the prevalence of renal dysfunction and the clinical status in admitted patients for decompensated HF. Material and Methods. 397 patients succesively hospitalized for decompensated HF, NYHA III or IV functional class, with left ventricular ejection fraction (LVEF) � 45% were included in the study. Renal dysfunction was defined by glomerular filtration rate (GFR) [ 60 mL/min/1.73 m 2. The mean GFR in patients with HF was 63.89 � 21.5 mL/min/1.73 m2 .The prevalence of renal dysfunction was 49.6%. Patients with GFR [ 60 mL/min/1.73m2, compared with those with preserved renal function were significantly more frequent older (75.37 � 6.84 vs. 71.33 � 8.08 years; p [0.001), females (53,8% vs. 43.5%; p = 0.04), had a significantly higher prevalence of diabetes mellitus (50.2% vs. 28.5%; p [0.001), atrial fibrillation (53.8% vs 46.2%, p = 0.04) and anemia (47.7% vs. 29.5% ; p [0.001). Also, patients with renal dysfunction had more severe HF than those without renal dysfunction (NYHA class IV: 65% vs 45%, p [0.001, clinical congestion: 78.2% vs 68%, p = 0.02, LVEF [35%: 47.21% vs � 35%, p [0.001). Renal dysfunction can be considered an additional marker of severe cardiac dysfunction along with NYHA IV class and low LVEF. The presence of both renal dysfunction and anemia could represent prognostic markers in HF patients with reduced LVEF.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Vitsenya ◽  
A Potekhina ◽  
S Gavryushina ◽  
N Ibragimova ◽  
V Masenko ◽  
...  

Abstract   Anthracycline-induced cardiomyopathy (AC-CMP) is more resistant or even refractory to conventional heart failure (HF) treatments and has a higher mortality rate as compared to HF associated with other diseases. Sacubitril/valsartan (S/V) significantly reduces cardiovascular mortality and hospitalization rate in HF patients with reduced left ventricular ejection fraction (HFrEF). There is lack of evidence of S/V efficacy and safety in patients with AC-CMP. We aimed to assess the efficacy and tolerability of S/V in patients with AC-CMP. Methods We enrolled 20 patients with anthracycline-induced HFrEF who met the indication criteria for S/V. Median age was 61 [51.5; 67], 100% women, 8 (40%) hypertensive, 1 (5%) diabetic. Seventeen (85%) patients had breast and 3 (15%) hematological cancers. Median time from anthracycline therapy was 3 [1; 11] years. Surgery due to cancer and radiation therapy were performed in 15 (75%) cases. All patients had been receiving ACE inhibitors or angiotensin II receptor blockers and were switched to S/V. 85% of patients were treated with beta-blockers, 60% – mineralocorticoid antagonists, 50% – loop diuretics. The exam (at admission and after 6 months) included 6-MWT, echo/speckle tracking, creatinine, potassium and NTproBNP level. Results Eleven (55%) patients achieved the target dose of S/V. The mean S/V dose was 289±149.1 mg. Symptomatic hypotension, hyperpotassemia or creatinine level elevation were the reasons for S/V dose reduction in 8, 1 and 2 patients, respectively. S/V wasn't withdrawn in any patient. No hospitalization due to HF or need for loop diuretics increase occurred during the follow-up. After 6 months 6-MWD increased from 416 [347.5; 477.5] to 465 [395; 513.5] m, p=0.0004. NYHA functional class improved in 50% of patients. We revealed LVEDVI decrease (61.7 [55.9; 71.6] to 57.1 [53.4; 60.1] ml/m2 p=0.002), LVEF and GLS increase (39 [34.7; 41] to 45 [39; 47]%, p=0.001 and 11 [8.7; 13.9] to 13.4 [11.9; 15.5]%, p=0.002, respectively), LAVI decrease (40.7 [32; 43.9] to 31.3 [28.6; 37.4] ml/m2, p=0.003), E/A and E/e ratios decrease (1.37 [0.7; 2.23] to 0.69 [0.64; 0.83], p=0.04, and 13 [11.3; 17.8] to 10.7 [6.9; 13.6], p=0.01, respectively). NTproBNP blood level declined from 1659 [1090; 2316] to 377 [206.8; 920] pg/ml, p&lt;0.001. There was change in serum creatinine level but in normal ranges (from 70.3 [66.8; 80; 6] to 77 [68.6; 96.3] micromol/l, p=0.02). No significant changes in potassium level were observed. Conclusions In this pilot study S/V was well tolerated in patients with AC-CMP, but cardiologic assessment was needed for accurate dose adjustment. Therapy with S/V was associated with improvement in HF functional class and LV systolic and diastolic function as well as neurohumoral status in patients with AC-CMP. Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Davydova ◽  
T.G Bezhanishvili ◽  
M.E Filatova ◽  
S.E Andreeva ◽  
A.A Streltsova ◽  
...  

Abstract Introduction Recently it is found that circulating miRNA-21 is associated with chronic heart failure (CHF) and ischemic heart disease. Its clinical significance in hypertrophic cardiomyopathy (HCM) and CHF with preserved left ventricular ejection fraction (LVEF) (≥50%) has to be investigated. Purpose The aim of this study was to analyze the expression of miRNA-21 in the peripheral blood of HCM patients and CHF with preserved LVEF (≥50%). Materials and methods From 2014 to 2019 years we examined 180 HCM patients. The study population consisted of 60 patients ≥19 years old (51.5 [36.2; 65.7]) with symptomatic HCM and CHF with preserved LVEF (≥50%). The diagnosis of HCM was established according to the guideline of the European society of cardiology on the diagnosis and treatment of HCM, 2014. The control group included 45 healthy donors without cardiovascular diseases and other severe pathologies, matched by age and sex with the studied group. Total RNA was extracted from plasma of patients. MiRNA-21 and reference RNA U6 cDNA was prepared based on StemLoop-technology. Expression was examined using semiquantitative RT-PCR protocol. Calculation of the relative gene expression level of miRNA-21 was done according to the standard procedure 2-ΔCt. IBM SPSS software package and Microsoft Excel 2010 were used for the statistical analysis of the collected data. Results The serum expression level of miRNA-21 in HCM patients (n=60) varied from 0.13 to 477.7 (4.92 [1.77; 13]) and was significantly higher than those in the control group (0.01 - 9.85 (0.84 [0.55; 1.23]), with statistically significant difference (p=0.001). The HCM group was divided according to CHF severity: I-II functional class (NYHA) (n=42) and III-IV functional class (NYHA) (n=18) subgroups. It was found a significant increase of expression microRNA-21 level in both subgroups HCM patients, compared with control group (p=0.001). The expression level of miRNA-21 also differed between HCM patients and CHF III-IV functional class (NYHA) vs those, who had CHF I-II functional class (NYHA) – 1.1–477.7 (13 [3.88; 41]) vs 0.1–119.4 (3.25 [1.41; 6.06]), respectively (p=0.003). In HCM patients and CHF III-IV functional class (NYHA) (n=18) the expression level of miRNA-21 positively correlated with LVEF (r=0.609; p&lt;0.05). Conclusion HCM patients with CHF III-IV functional class (NYHA) and preserved LVEF (≥50%) demonstrated high expression level of miRNA-21. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Almazov Federal Medical Research Centre, Saint-Petersburg, Russian Federation, Pavlov University, L'va Tolstogo str. 6-8, Saint Petersburg, Russian Federation


2018 ◽  
Vol 16 (8) ◽  
pp. 593-600
Author(s):  
Ploenpit THANIWATTANANON ◽  
Friska SINAGA

Osteoarthritis, as a common type of degenerative joint disease, puts older adults at high risk. It could impact the wellbeing of older adults, including physical, psychological, social, and economic factors. The aim of this study was to examine the effect of group support enhancing a self-management program on lifestyle modification behaviors among Indonesian older adults with knee osteoarthritis. Seventy-nine participants who met the inclusion criteria were recruited and assigned into the experimental group and the control group. Lifestyle modification behavior was measured during the first week, and after 6 weeks, of the program by using a Lifestyle Modification Behaviors Questionnaire (LMBQ). The internal consistency reliability coefficient of the LMBQ was 0.84. An independent t-test was conducted to examine the between group effect of the program. There was a statistically significant difference in lifestyle modification behaviors between the experimental group and the control group after receiving the program (t = 18.19, p = < 0.05). The group support enhancing self-management program effectively improved lifestyle modification behaviors among Indonesian older adults with knee osteoarthritis.


Cardiology ◽  
2015 ◽  
Vol 131 (3) ◽  
pp. 197-202
Author(s):  
Patrick Proctor ◽  
David Ryan King ◽  
Nicole M. Fesel ◽  
Sara Y. Narveson ◽  
William E. Anderson ◽  
...  

Objectives: Heart failure (HF) is associated with high mortality and frequent hospitalizations. Disease management programs (DMPs) have a favorable impact on patients with HF. No data exist regarding the outcomes of patients discharged from such a program. Methods: We examined the outcome of patients with severe systolic HF who were discharged from a DMP following full clinical and echocardiographic recovery. Data were reviewed for mortality, emergency room visits, hospitalizations, medication adherence and left ventricular ejection fraction (EF). Results: At enrollment and discharge, the mean EF was 19 and 53%, respectively. At follow-up 46.2 months after discharge, 56% of patients had been to the emergency room, 34% were hospitalized a total of 41 times and 20% had died. In the patients who required hospitalization for HF, the mean EF upon rehospitalization had dropped to 23.4%. Conclusions: Many patients with initially severe systolic HF who had an almost full recovery in a multidisciplinary DMP had very poor outcomes once they were discharged from the program. It may be appropriate to revisit the practice of discharging patients from DMPs once they have reached a specific clinical target.


2018 ◽  
Author(s):  
Xuyong Chen ◽  
Shasha Xie ◽  
Xiaojuan Yu ◽  
Zhibin Chen ◽  
Min Zhuo ◽  
...  

BACKGROUND The prevalence of chronic kidney disease (CKD) is approximately 850 million worldwide and 120 million in China. Approximately 2% of the CKD population will progress to end-stage renal disease (ESRD) requiring renal replacement therapy or transplantation. The total health care expenditure on dialysis for the entire ESRD population in China is estimated to be 240 billion RMB per year. Using mobile health information technologies to conduct low-cost, large-scale, and personalized populational health interventions show a great promise. OBJECTIVE In this pilot study, we assessed the feasibility and clinical effectiveness of a mobile application designed to improve patient's self-management of chronic kidney disease over a 3-month intervention with a pre-post design and a quasi-trial design. METHODS Patients with CKD stage 1-3 and uncontrolled proteinuria (proteinuria>1g per day) were recruited. Eligible patients who were waitlisted served as the control. Patients in the experiment group were invited to install a mobile application known as Shen Shang Xian (Chinese pinyin for kidney online) for CKD self-management. The enrollment included a questionnaire for medical history and self-reported objective physical parameters and laboratory values. Each participant was assigned to one nephrologist who communicated with the patient on an ad-hoc basis. Blood pressure and laboratory test results were entered by the patients on a regular basis. The application has a built-in clinical decision algorithm to generate health recommendations to users based on one's data-entry. The application also sends various alerts to patient's nephrologist for timely interventions. Blood pressure, proteinuria, serum creatinine and eGFR were measured before and after the management period. RESULTS Fifty-three patients were enrolled in the experimental group and 11 patients were in the control group. The average daily usage in minutes was 11.2 (25%-75% quartile [7.5, 16]) and the average of total physician-patient conversation was 116 (25%-75% quartile [51, 274]). There is a significant correlation between average daily usage and physician-patient conversation (R2=0.30, P<.001). The starting eGFR was 102 ml/1.73cm2 (95% CI 92-105]) in the experimental group and 118 ml/1.73cm2 (95% CI 100-134]) in the control group (P=.04). The body mass index (BMI), blood pressure, and proteinuria had no statistical significance. At the end of the study, the mean change of proteinuria was -1.39 g (95% CI -2.07 to -0.72]) in the experimental group and 0.37 g (95% CI -2.11-2.85]) in the control group (P=.14). After adjusted for ACEi/ARB use, the mean change of proteinuria was -1.46 vs 0.47 in the experimental group vs the control group respectively (P=.16). The eGFR was not changed at the end of the study. There was no correlation between the average daily use and change of proteinuria. CONCLUSIONS Participants used the mobile app on a daily basis and communicated with the nephrologists for their CKD management. Patients who used the CKD self-management app exhibited a non-statistically significant trend of proteinuria reduction after 3 months. This pilot study was underpowered and the follow-up period was short. A larger retrospective controlled trial is needed to confirm the effectiveness of mHealth app in CKD self-management.


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