A Trial of Family Partnership and Education Interventions in Heart Failure

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 HF patients and family member (FM) dyads (N = 117) were randomized to: usual care (UC), Patient-FM education (PFE), or a family partnership intervention (FPI). Dietary NA (3-day food record), Urine NA (24-hour urine) and MA (MEMS®) were measured at baseline (BL) prior to randomization, and at 4 and 8 months (M). Results FPI and PFE reduced Urine NA at 4 M, and FPI differed from UC at 8 M (p=.016). Dietary NA decreased from BL to 4M with both PFE (p=.04) and FPI (p=.018) lower than UC. The proportion of subjects adherent to NA intake (≤ 2500 mg/day) was higher at 8 M in PFE and FPI vs UC (χ2(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 the PFE and FPI interventions compared with UC. UC 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.

A systematic review of heart failure dyadic self-care interventions focusing on intervention components, contexts, and outcomes

“…(Dunbar et al, 2005;Dunbar et al, 2013) Guidance components were defined as specific verbal or written directions given during the intervention to improve care. All intervention studies included guidance component.…”

“…Countries where interventions were tested included the United States, (Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Piamjariyakul et al, 2015;Piette et al, 2008;Piette et al, 2015) Sweden, (Ågren et al, 2015;Agren et al, 2012) New Zealand, (Kenealy et al, 2015) Iran, (Hasanpour-Dehkordi et al, 2016) and Thailand. (Srisuk et al, 2015) Settings where the intervention was initiated or where the majority of the interventions were delivered included hospitals, (Agren et al, 2012;Bull et al, 2000;Hasanpour-Dehkordi et al, 2016;Kenealy et al, 2015;Piette et al, 2008;Schwarz et al, 2008) clinics, (Ågren et al, 2015;Agren et al, 2012;Dunbar et al, 2013;Piamjariyakul et al, 2015;Srisuk et al, 2015) home, (Agren et al, 2012) a U.S. Veterans Administration (clinic or hospital), (Piette et al, 2008;Piette et al, 2015) and in a clinical research center. (Dunbar et al, 2005) Two studies (Agren et al, 2012;Piette et al, 2008) included multiple sites to support the transition from hospital to home or increase recruitment.…”

“…The 12 interventions aligned into three delivery contexts -those which could be categorized as face-to-face; (Ågren et al, 2015;Agren et al, 2012;Bull et al, 2000;Dunbar et al, 2005;Dunbar et al, 2013;Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) telephone; (Piamjariyakul et al, 2015) or telehealth interventions (see Table 2). (Kenealy et al, 2015;Piette et al, 2008;Piette et al, 2015;Schwarz et al, 2008) Most face-to-face interventions also used some form of technology including DVD/video, (Bull et al, 2000;Dunbar et al, 2005;Srisuk et al, 2015) website, (Agren et al, 2012) or phone calls (Ågren et al, 2015;Dunbar et al, 2005;Dunbar et al, 2013;Srisuk et al, 2015) blurring the line between "high touch" and "high tech" modalities. It appears that all the studies were investigator-initiated and led.…”

“…Patient perceived control at 3 months (Ågren et al, 2015;Agren et al, 2012) and 12 months (Ågren et al, 2015) Carer perceived control at 3 months (Srisuk et al, 2015) Patient quality of life at 3 (Srisuk et al, 2015) and 6 months (Hasanpour-Dehkordi et al, 2016;Srisuk et al, 2015) Patient preparedness to care at 2 weeks (Bull et al, 2000) Carer reaction to caregiving (Bull et al, 2000) Patient knowledge (Dunbar et al, 2013) Patient/Carer knowledge (Dunbar et al, 2005;Srisuk et al, 2015) Patient perceived control at 12 months (Agren et al, 2012) Carer perceived control at 6 months (Srisuk et al, 2015) Patient/Carer perceived control at 24 months (Liljeroos et al, 2015) Patient quality of life at 3 months (Schwarz et al, 2008) Patient/Carer quality of life at 3 months (Agren et al, 2012) Patient quality of life at 6 months (Kenealy et al, 2015) Carer preparedness to care at 6 months (Piamjariyakul et al, 2015) Patient/Carer satisfaction with care (Bull et al, 2000) Patient ( …”

“…Patient self-care at 3 and 6 months (Srisuk et al, 2015) Carers attending visits (Piette et al, 2015) Patient self-care at 6 months (during intervention) (Kenealy et al, 2015) Patient medication adherence (Dunbar et al, 2013) Carer tasks Self-care for Patient…”