Is Adherence to Weight Monitoring or Weight-Based Diuretic Self-Adjustment Associated With Fewer Heart Failure-Related Emergency Department Visits or Hospitalizations?

Abstract

Background Heart failure (HF) self-care interventions can improve outcomes, but less than optimal adherence may limit their effectiveness. We evaluated if adherence to weight monitoring and diuretic self-adjustment was associated with HF-related ED visits or hospitalizations. Methods and Results We performed a case-control analysis nested in a HF self-care randomized trial. Participants received HF self-care training including weight monitoring and diuretic self-adjustment, which they were to record in a diary. We defined cases as HF-related ED visits or hospitalizations and the 7 preceding days; controls were defined as 7-day periods free of ED visits and hospitalizations. We used logistic regression to compare weight monitoring and diuretic self-adjustment adherence in cases and controls, adjusted for demographic and clinical covariates. Among 303 participants, we identified 81 HF-related ED visits or hospitalizations (cases) in 54 patients over one year of follow-up. Weight monitoring adherence (OR 0.42, 95% CI 0.23, 0.76) and diuretic self-adjustment adherence (OR 0.44, 95% CI 0.19, 0.98) were both associated with lower adjusted odds of HF-related ED visits or hospitalizations. Conclusions Adherence to weight monitoring and diuretic self-adjustment was associated with lower odds of HF-related ED visits or hospitalizations. Adherence to these activities may reduce HF-related morbidity.

Factors associated with beliefs about adherence to non-pharmacological treatment of patients with heart failure

“…Most did not have scales at home, which may have contributed to poor adherence to this measure. Having a scales in the household facilitates the establishment of a weight control routine (11)(12) , and may represent a crucial factor for the daily weight control in patients with HF (13) . Furthermore, the presence of significant positive correlation between weight control and the perceived Barriers subscale may explain the results obtained.…”

“…A study found that adherence to weight monitoring (OR=0.42; IC 95% 0.23-0.76; p<0.01) and diuretic adjustment (OR=0.44, 95% 0.19-0.98; p<0.05) reduce the chances of seeking emergency services and hospitalization, which may reduce the morbidity of HF (13) .…”

Randomized, Controlled Trial to Improve Self-Care in Patients With Heart Failure Living in Rural Areas

“…The rationale for the emphasis on weight monitoring and, if appropriate, diuretic self-adjustment was based on research demonstrating that adherence to this area of self-care is associated with fewer HF-related hospitalizations. 20 Nurses in the intervention session had a list of the patients' medications, and they tailored the medication teaching accordingly. On the basis of our pilot study in which patients kept a daily log but did not use the data to alert their physician when they experienced weight gain or increased HF symptoms, 21 we provided all patients in the 2 experimental arms with a script to use when calling their physicians, and we reviewed the importance of contacting a physician when they experienced weight gain or increased HF symptoms.…”

Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure

“…Symptoms are responsible for a decline in functional status, deteriorating health-related quality of life (HRQL), repeated hospitalization, and early demise (Falk et al, 2013;Murthy and Lipman, 2011;Song et al, 2010). A growing body of research demonstrates that self-care by patients can improve these outcomes (Ditewig et al, 2010;Jones et al, 2012;Tung et al, 2013). Self-care involves a process of maintaining physiological stability by monitoring symptoms, adhering to the treatment regimen (self-care maintenance), and promptly identifying and responding to symptoms (self-care management) .…”