Randomized Clinical Trial of an Integrated Self-Care Intervention for Persons With Heart Failure and Diabetes: Quality of Life and Physical Functioning Outcomes

• Authors: Sandra B Dunbar, Emory University; Carolyn Miller Reilly, Emory University; Rebecca A Gary, Emory University; Melinda K Higgins, Emory University; Steven D Culler, Emory University; Brittany Butts, Emory University; Javed Butler, Emory University
• Journal Title: Journal of Cardiac Failure
• Volume: Volume 21, Number 9
• Publisher: Elsevier | 2015-09-01, Pages 719-729
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.cardfail.2015.05.012
• Subjects: Health Sciences, Nursing; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Heart failure; diabetes; self-care; quality of life; intervention; LEFT-VENTRICULAR DYSFUNCTION; MINUTE WALK TEST; 6-MINUTE WALK; INDIVIDUALIZED QUESTIONNAIRE; COGNITIVE IMPAIRMENT; COST-EFFECTIVENESS; OLDER-ADULTS; HEALTH; MORTALITY; IMPACT

Abstract

Aim: Persons with concomitant heart failure (HF) and diabetes mellitus (DM) have complicated, competing, self-care expectations and treatment regimens that may reduce quality of life (QOL). This randomized controlled trial tested an integrated self-care intervention on outcomes of HF and DM QOL, physical function and physical activity (PA). Methods: Participants with HF and DM (n=134, mean age 57.4 ± 11 years, 66% men, 69% minority) were randomized to usual care attention control (control) or intervention groups. The control group received standard HF and DM educational brochures with follow up phone contact; Intervention received education/counseling on combined HF and DM self-care (diet, medications, self-monitoring, symptoms, and PA) with follow up home visit and phone counseling. Measures including questionnaires for HF and DM-specific, and overall QOL; Physical activity frequency; and physical function (6 minute walk test; 6MWT) were obtained at baseline, 3 and 6 months. Analysis included mixed models with a priori post-hoc tests. Results: Adjusting for age, body mass index, and comorbidity, the intervention group improved HF total (p=.002) and physical (p<.001) QOL scores at 3 months with retention of improvements at 6 months, improved emotional QOL scores compared to control at 3 months (p=.04), and improved health status ratings (p=.04) at 6 Months compared to baseline. The intervention group improved 6MWT distance (924 feet vs 952 feet, p=. 03) while control declined (834 vs 775 feet) (F1, 63=6.86, p=.01). The intervention group increased self-reported PA between baseline and 6M (p=.01). Conclusions: An integrated HF and DM self-care intervention improved perceived HF and general QOL but not DM QOL. Improved physical functioning and self-reported PA were also observed with the integrated self-care intervention. Further study of the HF and DM integrated self-care intervention on other outcomes such as hospitalization and cost is warranted.