Abstract 13356: Who Doesn't Respond to Motivational Interviewing for Heart Failure Self-care?

Abstract

Background: Motivational interviewing (MI) improves HF self-care yet fails to work for some patients. Lack of intervention response leaves clinicians and patients with fewer treatment options. Aim: Identify the characteristics of non-responders to MI in adults with HF. Methods: Secondary analysis of intervention group ( n =230) from MOTIVATE-HF trial. Study conducted in Italy to evaluate effectiveness of MI in improving HF self-care. Self-care maintenance measured with the validated Self-care of Heart Failure Index (SCHFI) v6.2 at baseline and 3 months from enrollment. Standardized scores range 0-100; changes > 7 pts from baseline are clinically significant. Participants dichotomized: MI non-responder (change in SCHFI < 7 pts) vs MI responder (change in SCHFI ≥ 7 pts). Logistic regression, adjusted for group differences (employment, income, living alone, HF etiology, baseline self-care, cognitive impairment, mutuality, medications, sleep quality, and HF health status), was used to estimate odds ratio with 95% confidence interval (OR [95% CI]) to identify determinants of non-response. Results: Half of the intervention group were non-responders to MI ( n =115) at 3 months. Non-responders were 72±13 years old and 53% male. Twice the number of non-responders were employed ( n =36 vs n =18, p <.005) and many reported ‘more than enough’ income (23% vs 13%, p <.046). They had more non-ischemic HF (79% vs 54%, p <.001), higher baseline self-care maintenance (48.8±19.2 vs 43.5±12.0, p <.009), and took fewer medications (6.1±3.0 vs 7.6±2.5, p <.009). Patients who responded to MI had worse HF quality of life ( p <.018), more sleep disturbances ( p <.042), and worse sleep quality ( p <.002). Significant risk factors for non-response were non-ischemic HF (2.606 [1.340-5.071], p <.005), fewer daily medications (0.829 [0.738-0.931], p <.002), and better baseline self-care maintenance (1.025 [1.001-1.050], p <.039). These variables explained 31% of HF self-care maintenance at 3 months (Nagelkerke R 2 =.309). Conclusion: MI may be less beneficial for patients with non-ischemic HF, lower medication burden, and relatively better self-care. Identifying characteristics of non-responders to MI in HF contributes to clinical decision making and personalized interventions.