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Author Notes:

The authors are grateful for the assistance of Mary Laszlo, Bridget Fielder, RN, MSN, and Kendaly Meadows, RN, MSN and the staff of the Atlanta Clinical and Translational Science Institute (ACTSI) who were invaluably instrumental in the conduct of this study.

Disclosures: None.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Research Funding:

Funded in part by the National Institutes of Health National Institute of Nursing Research grant number R01 R01NR011888 Cost Effectiveness and Quality of Life in patients with Heart Failure and Diabetes (PI-S.Dunbar), and grant number T32NR012715, and by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454 (PI-D. Stephens), and the Atlanta Veterans Administration Medical Center.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • Heart failure
  • diabetes
  • self-care
  • quality of life
  • intervention

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


Journal Title:

Journal of Cardiac Failure


Volume 21, Number 9


, Pages 719-729

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2015 Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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