Abstract 9185: Is Suboptimal Adherence to Weight Monitoring and/or Weight-Based Diuretic Self-Adjustment Associated with Heart Failure-Related Emergency Department Visits or Hospitalizations?

Abstract

Background Heart failure (HF) self-care interventions that include daily weights and diuretic self-adjustment to manage volume status can improve outcomes, but suboptimal adherence may limit their effectiveness. We sought to evaluate the association of 1) adherence to weight monitoring, and 2) adherence to a weight-based diuretic self-adjustment plan (WBDSA) with HF-related Emergency Department (ED) visits or hospitalizations. Methods We performed a case-control analysis nested in a HF self-care clinical trial. Participants received HF education over one year that covered topics including daily weight monitoring and personalized WBDSA plans. All participants were to record daily weights and loop diuretic doses in a specialized diary. Cases were 7-day periods preceding HF-related ED visits or hospitalizations determined by masked outcome adjudication. Controls were 7-day periods free of ED visits or hospitalizations and were matched to cases 10:1 for age, gender, NYHA class, and study site. Weight monitoring adherence required recording a weight; WBDSA adherence required recording a correct diuretic dose based on the WBDSA plan. Weight monitoring and WBDSA adherence were determined over 7 days and dichotomized into <6 versus >= 6/7 days of adherence. We used logistic regression to evaluate the odds of weight monitoring and WBDSA adherence in cases compared to controls and adjusted for age, gender, NYHA class, study site, literacy, socioeconomic ladder, systolic HF, cardiovascular disease, and chronic kidney disease. Results Among 303 participants, we identified 81 eligible cases [12 ED visits (15%) and 69 hospitalizations (85%)] in 54 patients. Weight monitoring adherence (OR 0.43, 95% CI 0.23, 0.81) and WBDSA adherence (OR 0.36, 95% CI 0.16, 0.82) were both associated with lower adjusted odds of a HF-related ED visit or hospitalization. Results were similar in unadjusted models for both weight monitoring adherence (OR 0.54, 95% CI 0.31, 0.95) and WBDSA adherence (0.36, 95% CI 0.16, 0.81). Conclusions Adherence to daily weight monitoring and WBDSA was associated with lower odds of ED visits or hospitalizations related to HF. Enhancing adoption and adherence for these self-care behaviors may be an important step in reducing HF-related morbidity.