Elsevier

Journal of Cardiac Failure

Volume 19, Issue 12, December 2013, Pages 829-841
Journal of Cardiac Failure

Clinical Investigation
A Trial of Family Partnership and Education Interventions in Heart Failure

https://doi.org/10.1016/j.cardfail.2013.10.007Get rights and content

Abstract

Background

Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA).

Methods and Results

HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ2(2) = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention.

Conclusions

Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.

Section snippets

Design

A 3-group randomized design with data collected at baseline (BL), and after 4 and 8 months was used. HF patients and 1 FM were randomized as dyads. The 3 randomization groups were: 1) UC, 2) PFE, and 3) FPI. The intervention was provided 1–2 months after BL measures were obtained. The time frame from BL to 4 months was considered to be the initiation phase of behavior change, and the time frame from 4 to 8 months was considered to be the maintenance phase of behavior change. We expected to see

Sample Characteristics

The recruitment procedures resulted in 170 consented dyads, and the CONSORT chart (Fig. 1) reflects randomization/attrition from groups. There was an overall attrition rate of 31% between consent and BL data collection because of 2 deaths and 51 withdrawals or loss to follow-up due to the HF patients' progressive illness, FM illness or dropout, loss of interest in the study, travel, or other activities that interfered with ability to participate. Thus, 117 dyads completed the BL data

Discussion

Based on the objective 24-hour urinary Na measures, the theory-based FPI intervention reduced dietary Na intake compared with UC at 8 months. The FPI, in addition to the education and feedback, was effective in fostering the initiation and maintenance of lifestyle changes needed to reduce dietary Na. The data reflect a sustained effect of lowering dietary Na intake in the FPI group even though we expected to see little change between 4 and 8 months (maintenance). Telephone booster sessions that

Acknowledgement

The authors acknowledge Judy Robinson, RN, MSN, Kendaly Meadows, RN, MA, Bridget Fielder, RN, MSN, Christina Quinn, RN, PhD, and Caroline Coburn, RN, DNP, for their outstanding contributions to this project.

Disclosures

None.

References (66)

  • J. Dunbar-Jacob et al.

    Treatment adherence in chronic disease

    J Clin Epidemiol

    (2001)
  • J.-R. Wu et al.

    Effect of a medication-taking behavior feedback theory-based intervention on outcomes in patients with heart failure

    J Card Fail

    (2012)
  • J.-R. Wu et al.

    Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure

    Heart Lung

    (2008)
  • M.L. Chung et al.

    Gender differences in adherence to the sodium-restricted diet in patients with heart failure

    J Card Fail

    (2006)
  • J.-R. Wu et al.

    Defining an evidence-based cutpoint for medication adherence in heart failure

    Am Heart J

    (2009)
  • J. Arcand et al.

    Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure: the confounding effect of loop diuretics

    Am J Clin Nutr

    (2011)
  • C. Lofvenmark et al.

    A group-based multi-professional education programme for family members of patients with chronic heart failure: effects on knowledge and patients' health care utilization

    Patient Educ Couns

    (2011)
  • Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al, Heart Failure Society of America....
  • B. Bentley et al.

    Factors related to nonadherence to low sodium diet recommendations in heart failure patients

    Eur J Cardiovasc Nurs

    (2005)
  • S.J. Bennett et al.

    Medication and dietary compliance beliefs in heart failure

    West J Nurs Res

    (2005)
  • J.R. Wu et al.

    Factors influencing medication adherence in patients with heart failure

    Heart Lung

    (2008)
  • S. Setoguchi et al.

    Temporal trends in adherence to cardiovascular medications in elderly patients after hospitalization for heart failure

    Clin Pharmacol Ther

    (2010)
  • K. Gudmundsson et al.

    Midsummer Eve in Sweden: a natural fluid challenge in patients with heart failure

    Eur J Heart Fail

    (2011)
  • M.D. Murray et al.

    Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills

    Clin Pharmacol Ther

    (2009)
  • S.J. Bennett et al.

    Characterization of the precipitants of hospitalization for heart failure decompensation

    Am J Crit Care

    (1998)
  • A.M. Clark et al.

    Patient and informal caregivers' knowledge of heart failure: necessary but insufficient for effective self-care

    Eur J Heart Fail

    (2009)
  • K.J. Flynn et al.

    Increasing self-management skills in heart failure patients: a pilot study

    Congest Heart Fail

    (2005)
  • B. Smith et al.

    Educational attainment has a limited impact on disease management outcomes in heart failure

    Dis Manag

    (2006)
  • A.M. Rosland et al.

    Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help?

    Chronic Illn

    (2010)
  • G.J. Molloy et al.

    Family caregiving and congestive heart failure. Review and analysis

    Eur J Heart Fail

    (2005)
  • M.M. Saunders

    Factors associated with caregiver burden in heart failure family caregivers

    West J Nurs Res

    (2008)
  • S.B. Dunbar et al.

    Family influences on heart failure self-care and outcomes

    J Cardiovasc Nurs

    (2008)
  • R. Gallagher et al.

    Social support and self care in heart failure

    J Cardiovasc Nurs

    (2011)
  • Cited by (68)

    • Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants

      2020, American Journal of Medicine
      Citation Excerpt :

      Three studies found that sodium-restricted diet interfered with social life.33,46,52 Informal caregivers influenced sodium-restricted diet in 5 studies26,34,36,43,44 and health care providers influenced sodium intake in one study.43 One randomized controlled trial provided30 educational activities tailored to taste preferences by helping patients to identify their favorite low-sodium foods at restaurants, plan sample menus, and familiarize themselves with low-sodium substitutes.

    View all citing articles on Scopus

    Funding: “A Family Partnership Intervention for Heart Failure” (RO1 R08800), National Institute of Nursing Research, National Institutes of Health (NIH), July 1, 2004–November 30, 2009; Public Health Service (PHS) grants M01 RR0039 from the General Clinical Research Center program and UL1 RR025008 from the Clinical and Translational Science Award program, National Center for Research Resources, NIH; and Nitromed.

    See page 840 for disclosure information.

    View full text