Heart failure symptom monitoring and response training

Objective: The purpose of this study was to test the efficacy of a heart failure ( HF ) training program on patients' ability to recognize and respond to changes in HF symptoms. The primary aim was to compare event-free survival at 90 days. Methods: A total of 99 HF patients randomized to the HF symptom training intervention or usual care completed instruments about self-care ( Self-Care of HF Index ) and at baseline and 3 months. Demographic, clinical, and comorbidity data were collected by interview and chart review. Time to first event ( death or a HF-related hospitalization ) was tracked by electronic records and patient interview. Results: The sample was predominately male ( 67.7% ), elderly ( 67.7 yrs ± 12.1 ) and Caucasian ( 88.9% ). The intervention group reported more events but the difference was not significantly different ( χ2 = 1.18, p = 0.26 ). There was no difference in survival time between groups ( χ2 = 1.53, p = 0.216 ). In paired t-tests, the intervention group had significantly improved self-care maintenance, management and confidence scores ( all p < 0.01 ). The usual care group had significantly improved self-care maintenance and management ( both p < 0.01 ). Improvements in self-care maintenance and confidence were higher in the intervention group compared with usual care ( 18.0 vs. 12.9 points ). Conclusions: HF symptom awareness training appeared to have an early but not sustained benefit resulting in no difference in 90-day event-free survival. However, larger improvement in self-care maintenance and confidence scores in the intervention group compared to usual care is promising. Embedding meaningful symptom monitoring strategies in self-care maintenance interventions requires further investigation.