Abstract
BackgroundPresently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging.ObjectiveThis study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF.MethodsA prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up.ResultsA paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t 49=0.66; P=.01), HF knowledge (t 49=0.71; P=.01), medication adherence (t 49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t 49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults.ConclusionsSTS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes.
Highlights
Background and SignificanceHeart failure (HF) is a clinical syndrome affecting 6.5 million Americans and is a growing problem around the world [1]
More than 100 records were reviewed to identify the patients with heart failure (HF) at Program of All-Inclusive Care for the Elderly (PACE), and of those with the HF diagnosis, 85 were contacted for possible participation in the study over a 3-month period
The results demonstrated that structured telephone support (STS) and SMS significantly improved HF self-care maintenance, self-care management, and self-care confidence and knowledge, medication adherence, and physical and mental health (Short-Form-12; SF-12) at 30 days and sustained improvement at 3 months with P
Summary
Background and SignificanceHeart failure (HF) is a clinical syndrome affecting 6.5 million Americans and is a growing problem around the world [1]. 6.5 million Americans are living with heart failure (HF) These patients are expected to follow a complex self-management regimen at home. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging. Results: A paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P
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