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

Abstract

Aims 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.

Early declines in physical function among aging adults with type 2 diabetes

“…Physical function was measured using the six-minute walk test (6MWT) (Guyatt et al, 1985) a common field test shown to be reliable, valid, and safe in adults (including elderly adults) with a variety of medical conditions, including diabetes (Alfonso-Rosa, Del Pozo-Cruz, Del Pozo-Cruz, Sanudo, & Rogers, 2014; Dunbar et al, 2015; Ekman, Klintenberg, Bjorck, Norstrom, & Ridderstrale, 2013; Enright, 2003; Enright et al, 2003; Mangeri, Montesi, Forlani, Dalle Grave, & Marchesini, 2014; Pariser, Ann Demeuro, Gillette, & Stephen, 2010). The 6MWD has been shown to reflect the capacity for usual daily activities (Zeballos & Weisman, 2002) and walking ability (Ekman et al, 2013).…”

An Economic Evaluation of a Self-Care Intervention in Persons With Heart Failure and Diabetes

“…20, 21 Participants were recruited during or within 3 months of an inpatient HF hospitalization at one of four participating urban hospitals between 2011 and 2013. All were large tertiary care facilities with HF outpatient clinics.…”

“…22 A detailed explanation of the intervention is available in the accompanying article that fully describes the primary goals and outcomes of the study. 20 The intervention was based on principles of adult learning, motivation and feedback, goal setting and provided both content and self-management strategies. 23–28 The intervention was initiated in the hospital setting or soon after baseline data collection and study enrollment, and initially included an individualized educational and counseling session.…”

“…The self-care intervention improved HF quality of life, physical function and self-reported physical activity. 20 This analysis of HRU and costs was undertaken to provide a comprehensive picture for determining the usefulness of the intervention and implications for translation into practice.…”

Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions

“…A study supported by NINR demonstrated that an integrated intervention for individuals with both heart failure and diabetes was effective in improving components of self-care and had sustained effects on selected health care behaviors. (Dunbar et al, 2015)…”