Self-care Management Intervention in Heart Failure (SMART-HF): A Multicenter Randomized Controlled Trial

Abstract

Background: Self-care behavior is important in avoiding hospitalization for patients with heart failure (HF) and refers to those activities performed with the intention of improving or restoring health and wellbeing, as well as treating or preventing disease. The purpose was to study the effects of a home-based mobile device on self-care behavior and hospitalizations in a representative HF-population. Methods and Results: SMART-HF is a randomized controlled multicenter clinical trial, where patients were randomized 1:1 to receive standard care (control group [CG]) or intervention with a home-based tool designed to enhance self-care behavior (intervention group [IG]) and followed for 240 days. The tool educates the patient about HF, monitors objective and subjective symptoms and adjusts loop diuretics. The primary outcome is self-care as measured by the European Heart Failure Self-care behavior scale and the secondary outcome is HF related in-hospital days. A total of 124 patients were recruited and 118 were included in the analyses (CG: n = 60, IG: n = 58). The mean age was 79 years, 39% were female, and 45% had an ejection fraction of less than 40%. Self-care was significantly improved in the IG compared to the CG (median (interquartile range) (21.5 [13.25; 28] vs 26 [18; 29.75], p = 0.014). Patients in the IG spent significantly less time in the hospital admitted for HF (2.2 days less, relative risk 0.48, 95% confidence interval 0.32À0.74, P = .001). Conclusions: The device significantly improved self-care behavior and reduced in-hospital days in a relevant HF population.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis

“…Pedone et al [ 48 ] I: Multiparametric TM with smartP + phone support C: UC (edu, monthly follow-up, telephone availability 2 h/day during the week) I: 47 C: 43 I: 79.9 (6.8) C: 79.7 (7.8) I: (30.2) C: (46.8) I: II (31.9) III (57.4) IV (10.6) C: II (32.6) III (55.8) IV (11.6) I: 44.4 (12.7) C: 48.2 (13.5) NR 6 Dx based on echocardiography, NT- proBNP De novo HF in hx or as 1st dx in outpatient clinic ≥ 65 years All cause mort All cause Hx 10. Sahlin et al [ 49 ] I: HIS—OPTILOGG (tab) close loop C: UC (HF Clinic, trimestral visits) I: 58 C: 60 I: 80 (8) C: 77 (11) I: 39 (67) C: 32 (53) I: I 6 (11) II 36 (63) III 15 (26) IV 0 (0) C: I 2 (3) II 39 (65) III 19 (32) IV 0 (0) NR I: Isq 26 (45) C: HT 27 (45) 8 ESC 2016 guidelines HHF ≤ 12mo NR All cause mort HHF All cause Hx # days for HHF # days all cause Hx 11. Koehler et al [ 25 ] I: TM Tab Physio-Gate PG 1000 + edu.…”

“…for Sto Alarm for TM Alarm if OOGM w app daily assessment Alarm If OOGM, ➔contact pt, adherence check, early appointment, emergency room referral Phone support business hours to report sto or technical help NR 10. Sahlin et al [ 49 ] OPTILOGG Tab. wl scale Weight Sto DoM Freq.…”

“…1 . Only two (10%) RCTs were ranked as low risk of bias [ 49 , 54 , 55 ], whereas twelve (63%) presented at least some concerns of bias with regard to outcomes such as mortality and/or hospitalization.…”

Multicomponent integrated care for patients with chronic heart failure: systematic review and meta‐analysis

“…Of the 6164 RCTs screened, 105 RCTs 25–27,29–33,35–37,39–132 ( n = 37 607 patients with CHF) were eligible ( Figure ). Table summarizes the study population characteristics, type of intervention, and study outcomes.…”

The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study

“…In a Chinese study involving 321 patients with HF, only 7% of the participants showed adequate self-care maintenance behaviours, and 24% demonstrated adequate management behaviours [ 7 ]. Inadequate self-care behaviours have been linked to increased incidence of clinical events such as all-cause mortality, emergency room visits, and HF-related hospitalizations, as well as poorer quality of life [ 8 , 9 ]. Considering the negative impact of inadequate self-care, it is crucial to identify and address the factors that affect the self-care behaviours of individuals who demonstrate inadequate self-care in both clinical practice and research endeavours.…”