Related Experiment Videos
Self-management counseling in patients with heart failure: the heart failure adherence and retention randomized
Lynda H Powell1, James E Calvin, Dejuran Richardson
1Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren St, Chicago, IL 60612, USA. lpowell@rush.edu
JAMA
|September 23, 2010
Summary
Self-management counseling did not improve outcomes for heart failure patients. Adding self-management skills to education did not reduce death or hospitalizations compared to education alone.
Area of Science:
- Cardiology
- Behavioral Science
- Public Health
Background:
- Motivating heart failure patients to adhere to medical advice has shown limited clinical benefit.
- Previous trials investigating adherence interventions faced methodological limitations.
Purpose of the Study:
- To evaluate the effectiveness of self-management counseling combined with heart failure education.
- To compare this combined intervention against heart failure education alone.
- To assess the primary endpoint of death or heart failure hospitalization.
Main Methods:
- A randomized controlled trial involving 902 patients with mild to moderate heart failure.
- Interventions included 18 educational contacts and tip sheets over 1 year.
- One group received education via mail and phone; the other received group education and self-management skills training.
Main Results:
- The primary endpoint rate (death or heart failure hospitalization) was similar between groups (40.1% vs. 41.2%).
- No significant differences were observed in secondary endpoints, including death, hospitalization rates, or quality of life.
Conclusions:
- The addition of self-management counseling to enhanced heart failure education did not significantly reduce death or heart failure hospitalizations.
- Current evidence suggests that enhanced educational interventions alone may be as effective as adding self-management counseling for this patient population.
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:30Heart Failure VII: Nursing Interventions
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
01:28Mitral Regurgitation IV: Nursing Management
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
01:29Cardiomyopathy VI: Nursing Management
Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
01:23Hypertension V: Nursing Management
The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.