Effect of behavioral management on quality of life in mild heart failure: a randomized controlled trial
Introduction
It is well known that heart failure is a significant and growing health care problem with high mortality, reduced quality of life and significant economic burden on society [1]. Patient management and guideline recommendations include encouraging patients to be more active in their own care, patient and family education, symptom management, exercise training, dietary modification, and adherence to the prescribed medications [1], [2], [3]. Behavioral self-management in patients with heart failure may help to control symptoms, maintain function, avoid preventable re-hospitalization, and ultimately decrease morbidity and mortality. One desired outcome from behavioral self-management is enhanced health related quality of life (HRQL); however, only a few groups have reported behavioral interventions specific to heart failure [4], [5]. Evaluation of behavioral interventions is still lacking and interventions to improve HRQL in patients with heart failure still need to be tested. The primary objective of this study was to determine the effect of a nurse-led behavioral management intervention on HRQL in patients with mild heart failure. It was hypothesized that patients who participated in a nurse-led behavioral management intervention as compared to usual care over a 16-month follow-up period (baseline, 4, 10, and 16 months) would have improved exercise performance, physical functioning, mental functioning, and general health perceptions.
Section snippets
General design
This was a randomized clinical trial design (Fig. 1). Following eligibility screening and consent, 116 patients were randomly assigned to one of two treatment groups to evaluate the clinical impact of the intervention. A stratified blocked randomization approach based on the Specific Activity Scale (SAS) was used to assure that patients were equally distributed based on functional performance. The control group received usual care for patients with heart failure (n = 58). The intervention group
Patient characteristics
A total of 116 patients enrolled in the study. Participants were primarily male (n = 110, 95%), reflecting the VA population, and Caucasian (n = 87, 75%). The mean age of the entire sample was 67 years (S.D. = 10); ages ranged from 41 to 90 years. The median ejection fraction for both groups was 40%; these data were available in 69 (60%) of the participants from the total sample. Heart failure etiology was available for 88 (76%) of the 116 participants. The most frequently reported etiologies
Discussion
The important results from this study are in the domain of physical functioning. The physical functioning measures included an objective measurement of exercise performance (the 6-min walk) and a self-report measure of impairment due to heart failure (MLHF physical functioning score). The MLHF self-report measure demonstrated a better outcome in the participants randomized to the behavioral management intervention compared to the control group. The 6-min walk was significantly better only with
Conclusions and practice implications
This study demonstrates efficacy of the behavioral management intervention on a self-reported disease specific physical functioning. This study is unique in that it focused on HRQL as a primary patient outcome, used both generic and disease-specific questionnaires for measuring HRQL, tracked HRQL longitudinally, and examined optimal timing of the behavioral management intervention, as well as measurements to evaluate the intervention. The major practice implication suggested by this study is
Acknowledgements
We gratefully acknowledge the work of research associates Debbie Dugan, MS, RN, Malinda Fox, MS, RN, Joan Hall, MS, RN, Mary Jane Hoban, MS, RN, Lien Khuat, MS, RN, Vicki McCalmont, MS, RN, Kimberly Newell, MS, RN, Beth Schanke, MS, RN; database management specialist Jo-Anne Toomey, MBA; quality control consultant Ann Bryant, MS, RN; data review board members Kirk Peterson, MD, Barbara Riegel, DNSc, RN; intervention advisors Sheri Pruitt, PhD and Allen Gifford, MD; and general support of the VA
References (25)
- et al.
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summaryA report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure),
J Am College Cardiol
(2001) - et al.
Nonpharmacologic therapy improves functional and emotional status in congestive heart failure
Chest
(1994) - et al.
Validity of the Minnesota Living with Heart Failure Questionnaire as a measure of therapeutic response to Enalapril or placebo
Am J Cardiol
(1993) - et al.
Psychosocial recovery from a cardiac event: the influence of perceived control
Heart Lung
(1995) - et al.
Perceived control reduces emotional stress in patients with heart failure
J Heart Lung Transplant
(2003) - et al.
Heart failure, evaluation and care of patients with left-ventricular systolic dysfunctionClinical Practice Guideline No. 11.
(1994) - et al.
Team management of patients with heart failure: a statement for healthcare professionals from The Cardiovascular Nursing Council of the American Heart Association
Circulation
(2000) - et al.
Impact of biofeedback-relaxation training on hemodynamics, neuroendocrine function and rehospitalizations in advanced heart failure (abstract)
Am J Crit Care
(1999) - et al.
Changing AIDS-risk behavior
Psychol Bull
(1992) - et al.
Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population
Health Psychol
(1996)
A critical appraisal of the quality of quality-of-life measurements
JAMA
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A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies
2019, Patient Education and CounselingCitation Excerpt :Studies assessed a wide range of participant outcomes (Table 3) that were categorized into the seven outcome categories (i.e. Process, Resource, Health Behaviour and Disease Controlling, Emotional, Activities and Social Interaction, Global Self-Efficacy, Global Quality of Life and Global Disease). Outcomes related to Health Behaviour and Disease Controlling (n = 21/31) [45,47,49,51,52,54,55,58,59,61–64,67,69,70,72–76] and Global Quality of Life (n = 19/31) [45,47–51,53,54,56,57,59,60,62,65,66,72–75] outcomes were the most commonly assessed outcomes. Seventy-one percent of the studies assessing Health Behaviour and Disease Controlling outcomes showed significant differences between the intervention and control groups, compared to 37% of the studies assessing Global Quality of Life.
Heart Failure
2018, Integrative Medicine: Fourth EditionTherapeutic patient education in heart failure: Do studies provide sufficient information about the educational programme?
2014, Archives of Cardiovascular DiseasesCitation Excerpt :No study asked about the patient's perception of TPE usefulness and the existence of a personal project. Record keeping (one study: [24]), smoking and alcohol cessation (five studies [25,32,33,37,40]), family support (three studies [23,35,36]), social functioning (three studies [35,37,40]), preventive behaviours (one study: [37]) and management of co-morbidities were seldom mentioned. Better communication with the health care provider was never cited.