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The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study
Vilnius Univ, Lithuania; Vilnius Univ Hosp Santaros Clin, Lithuania.
Oslo Univ Hosp, Norway; Univ Oslo, Norway.
Oslo Univ Hosp, Norway.
Vilnius Univ, Lithuania.
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2018 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 12, p. 1113-1122Article in journal (Refereed) Published
Abstract [en]

Introduction: Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited. Aims: This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care. Methods: In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69 +/- 11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ). Results: The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p amp;lt; 0.01) but not in the TM+ICT-guided-DMS group. Factors associated with self-care worsening were as follows: higher physical subscale of MLHFQ (per 10 points, p amp;lt; 0.05), lower left ventricular ejection fraction (LVEF) (per 5%, p amp;lt; 0.05), lower New York Heart Association (NYHA) class (class III vs class II, p amp;lt; 0.05). The subgroups of patients who had an initial EHFScBs total score amp;gt; 28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score amp;lt;= 8, demonstrated the greatest potential to improve self-care during the study. Conclusion: TM did not have an advantage on self-care improvement. Poor physical aspect of quality of life. lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD , 2018. Vol. 12, p. 1113-1122
Keywords [en]
heart failure; self-care; telemonitoring; disease management; patient-reported outcomes
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-149751DOI: 10.2147/PPA.S162219ISI: 000437184500001PubMedID: 29983549OAI: oai:DiVA.org:liu-149751DiVA, id: diva2:1234360
Note

Funding Agencies|Dutch Ministry of Health, Department of Pharmaceutical Affairs and Medical Technology (GMT); NordForsks "Nordic Programme on Health and Welfare" [76015]

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2019-06-27Bibliographically approved

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Strömberg, AnnaJaarsma, Tiny
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Faculty of Medicine and Health SciencesDepartment of Cardiology in LinköpingDivision of Nursing ScienceDivision of Nursing Science
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