A Trial of Family Partnership and Education Interventions in Heart Failure

• Type of Material: Article
• Authors: Sandra B Dunbar, Emory University; Patricia Clark, Emory University; Carolyn Miller Reilly, Emory University; Rebecca A Gary, Emory University; Andrew L Smith, Emory University; Frances McCarty, Emory University; Melinda K Higgins, Emory University; Daurice Grossniklaus, Emory University; Nadine Kaslow, Emory University; Jennifer Frediani, Emory University; Carolyn Dashiff, University of Alabama; Richard Ryan, University of Rochester
• Language: English
• Date: 2013-12-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.cardfail.2013.10.007
• Title of Journal or Parent Work: Journal of Cardiac Failure
• ISSN: 1071-9164
• Volume: 19
• Issue: 12
• Start Page: 829
• End Page: 841
• Grant/Funding Information: This study was supported by (1) A Family Partnership Intervention for Heart Failure”, (RO1 R08800) National Institute of Nursing Research, NIH 07/01/04-11/30/09, PI: S. Dunbar and in part by PHS Grant M01 RR0039 from the General Clinical Research Center program, National Institutes of Health, National Center for Research Resources and PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources and Nitromed for unrestricted educational grant.
• Keywords: SUPPORT; Science & Technology; adherence; dietary sodium; medication adherence; autonomy support; HEALTH; WEIGHT-LOSS MAINTENANCE; Cardiovascular System & Cardiology; GLYCEMIC CONTROL; Cardiac & Cardiovascular Systems; CLINICAL-TRIAL; MEDICATION-ADHERENCE; Life Sciences & Biomedicine; PREDICTIVE-VALIDITY; CARE; SELF-DETERMINATION THEORY; Self management; SODIUM
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Background Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA). Methods and Results HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P =.016). Dietary Na decreased from BL to 4 months, with both PFE (P =.04) and FPI (P =.018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ 2 (2) = 7.076; P =.029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention. Conclusions Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.