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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
Insights
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.
Context:
Motivating patients with heart failure to adhere to medical advice has not translated into clinical benefit, but past trials have had methodological limitations.
Objective:
To determine the value of self-management counseling plus heart failure education, compared with heart failure education alone, for the primary end point of death or heart failure hospitalization.
Design, Setting, And Patients:
The Heart Failure Adherence and Retention Trial (HART), a single-center, multiple-hospital, partially blinded behavioral efficacy randomized controlled trial involving 902 patients with mild to moderate heart failure and reduced or preserved systolic function, randomized from the Chicago metropolitan area between October 2001 and October 2004 and undergoing follow-up for 2 to 3 subsequent years.
Interventions:
All patients were offered 18 contacts and 18 heart failure educational tip sheets during the course of 1 year. Patients randomized to the education group received tip sheets in the mail and telephone calls to check comprehension. Patients randomized to the self-management group received tip sheets in groups and were taught self-management skills to implement the advice.
Main Outcome Measure:
Death or heart failure hospitalization during a median of 2.56 years of follow-up.
Results:
Patients were representative of typical clinical populations (mean age, 63.6 years; 47% women, 40% racial/ethnic minority, 52% with annual family income less than $30,000, and 23% with preserved systolic function). The rate of the primary end point in the self-management group was no different from that in the education group (163 [40.1%)] vs 171 [41.2%], respectively; odds ratio, 0.95 [95% confidence interval, 0.72-1.26]). There were no significant differences on any secondary end points, including death, heart failure hospitalization, all-cause hospitalization, or quality of life.
Conclusions:
Compared with an enhanced educational intervention alone, the addition of self-management counseling did not reduce death or heart failure hospitalization in patients with mild to moderate heart failure.
Trial Registration:
clinicaltrials.gov Identifier: NCT00018005.
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