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Improving Self Care Behavior and Outcomes in Rural Patients with Heart Failure
Kathleen Dracup (UCSF), Principal Investigator
Debra Moser, D.N.Sc.,
Site PI
Funded by the National
Institutes of Health/National Heart, Lung, & Blood
Institute
Grant #1R01 HL083176-01A1
(8/1/2006-4/30/2011)
Abstract
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Self-monitoring and timely response by heart failure (HF)
patients to worsening symptoms caused by fluid overload (the
primary reason for hospital readmissions) are important to
minimize myocardial damage. However, patients often ignore
symptoms or are reluctant to seek care. Disease management
models have improved outcomes but are limited to major urban
centers and are unavailable in rural areas. These programs
are also based on treatment guidelines for systolic HF (SHF)
and not patients who suffer from diastolic HF (DHF).
The purpose of this study is to test the effects on
clinical outcomes (HF-related hospital readmissions,
mortality, HF severity, quality of life [QOL]), self-care
monitoring and behaviors, care-seeking behaviors, patient
knowledge and cost) of two doses of an easily administered
education intervention focused on fluid weight management
(Fluid Watchers) designed specifically for rural patients.
710 HF subjects will be randomized to one of three groups
(usual care [UC], Fluid Watchers LITE or PLUS) at rural
sites in California, Kentucky and Nevada. Patients in Fluid
Watchers LITE and PLUS groups will receive counseling about
HF and self-monitoring, and coaching on seeking care. The
PLUS group will also receive additional counseling, audio
tapes and telephone followup. Data will be collected at
baseline, three, 12 and 24 months. Instruments include a
knowledge questionnaire, HF Self-Care Behavior Scale, and
The Minnesota Living with Heart FailureQOL instrument.
Diaries will be used to measure adherence and healthcare
provider contacts (self-care monitoring and care seeking
respectively).
This study is unique because it is a single component
intervention with two doses designed for rural or
resource-scarce settings, conducted in patients with both DHF and SHF, with long term follow-up over
two years. If
effective, this intervention would be broadly applicable and
lend valuable insight about treatment of HF in rural
settings. Self monitoring and timely response to symptoms by
HF patients is important to minimize heart damage. HF
interventions have not been developed for resource scarce
rural areas. The intervention tested here could help
patients with HF in rural areas avoid hospitalizations.
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