Abstract 15892: Symptom Diary Use Improves Outcomes for Heart Failure Patients

Abstract

Introduction: Attention to symptoms of weight gain and dyspnea are central tenets in heart failure (HF) patient education. Daily diary use can be one method for HF patients to acknowledge and attend to their symptoms. However, it is not known whether diary use improves patient outcomes. We aimed to compare mortality among rural HF patients who did versus did not complete a daily diary of weight and symptom self-assessment. Methods: This study was a secondary analysis of a 3-arm randomized controlled trial with two intervention groups (Fluid Watchers LITE and PLUS) and usual care. The two intervention groups were given daily diaries for 2 years to track daily weight, HF symptoms, and response to symptom changes. Intervention group patients received self-care education and a script to call their health care provider, but the 2 groups varied on the number of follow-up phone calls received. Patient groups were categorized by duration of adherence to diary use: None, Low (1-3 months), Medium (4-12 months), and High (13-24 months). Cox regression analysis assessed survival from cardiac and non-cardiac death for 2 years while controlling for age and depression. Results: The mean age was 66 ± 13, 58% (n=227) were male, and 67% (264/393) completed diaries with no difference in diary use between the 2 intervention groups. As compared with the 129 patients with no diary use, the 117 patients with High diary use had fewer non-cardiac (p=0.001) and cardiac (p=0.01) deaths; the 89 patients with Medium diary use had fewer non-cardiac deaths (p=0.007) but similar cardiac deaths (p=0.79). Conclusions: This is the largest trial to examine daily diary use in HF patients over 2 years. Improved non-cardiac survival was associated with at least 4 months of diary use, while cardiac survival was associated with at least 12 months of diary use. It is unclear why non-cardiac survival improved, but it is speculated that attention to cardiac symptoms may have increased attention to non-cardiac symptoms.