Heart Failure Knowledge Research Articles

Translation and psychometric evaluation of the Chinese version of the Heart Failure-Specific Health Literacy Scale

ObjectiveHealth literacy is closely associated with self-care behaviors in heart-failure patient. A reliable, valid, and practical measuring tool would evaluated the level of health literacy in Chinese patients with heart failure, and provide evidence for individualized education. Aim of this study was to translate Heart Failure-Specific Health Literacy Scale (HF-Specific HL Scale) into Chinese and test the reliability and validity of the Chinese version. MethodsThe original HF-specific HL scale was translated into Chinese and modified for cultural adaption. Totally 164 HF inpatients were investigated with the Chinese version of HF-specific HL scale. To test the reliability and validity of the scale, item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlation analysis were conducted. ResultCronbach's α value for the scale is 0.87; the correlation coefficients between each item and the total score ranged from 0.61 to 0.91. Three factors was extracted by EFA, which could explain 64.62% of the total variance. The result of CFA also showed that the scale demonstrated an acceptable model fit. The scale was significantly correlated with the Chinese version of the Heart Failure Knowledge Test (C-HFKT). ConclusionThe Chinese version of HF-specific HL scale is reliable and valid, and is suitable for assessment of HL in Chinese HF patients.

Abstract 12114: Effects of an Educational Intervention on Disease Knowledge and Self-care Behaviors of Patients With Heart Failure: A Randomized Controlled Trial

Introduction: In this randomized clinical trial, we tested the effects of an educational intervention designed to improve disease knowledge and self-care behaviors of patients with heart failure (HF). Methods: Patients with HF (n=602; 41% female, age 66.1 ± 12.9 years) were randomized into control (usual care) or 1 of 2 intervention groups: Fluid Watchers LITE (LITE) or Fluid Watchers PLUS (PLUS). Patients in both intervention groups received face-to-face education on HF self-care led by a nurse, and then received either 2 follow-up phone calls (LITE group) or biweekly calls until they demonstrated content competency (PLUS group). The levels of HF knowledge and self-care behaviors were measured with self-report questionnaires at baseline and 3, 12, and 24 months. Data were analyzed using linear mixed-models. Results: The 3 groups were not significantly different in their HF knowledge and self-care at baseline. Significant group-by-time interactions were found in models for knowledge and self-care (Figure). Both intervention groups showed improvement in HF knowledge at 3 months, but the improvement lasted only in the PLUS group throughout 24 months. Both intervention groups exhibited significantly better self-care behaviors at 3 and 12 months compared with the control group. The intervention effects on self-care remained stable in both groups, but were not significant at 24 months. Results were similar when covariates (i.e., socioeconomic characteristics and baseline psychological status) were controlled in the models. Conclusions: The face-to-face educational intervention was effective in improving disease knowledge and self-care behaviors among patients with HF. Both intervention groups showed improvement in knowledge and self-care at 3 months, and their effects on self-care remained significant until 12 months. In addition, the intervention with more follow-up calls resulted in greater and more sustained improvement in knowledge about HF.

Abstract 11886: The Impact of Poor Understanding of Heart Failure and Its Symptoms on Self-care

Introduction: A comprehensive understanding of heart failure (HF) and its symptoms is one of the goals of patient education. Patients cannot be expected to adequately perform self-care and respond to symptoms appropriately with incomplete understanding of HF and its symptoms. Purpose: To examine whether levels of understanding of HF and its symptoms predicts self-care in HF patients who had a recent hospitalization for HF symptoms. Methods: Patients with HF (N=577, mean 66 years, 41% female, 35% NYHA III/IV) completed the 9-item European HF Self-care Behavior scale to assess self-care. The HF Knowledge Questionnaire was used to assess knowledge of HF and its symptoms. Three groups were formed by their different levels of understanding of HF and its symptoms: poor, moderate, and complete. Linear regression was used to determine whether levels of understanding of HF and its symptoms predicted self-care after controlling for age, gender, education, marital status, comorbidity, NYHA functional class, and depressive symptoms. Results: Of 577 patients, 16% and 32% of the patients had poor and moderate understanding of HF and its symptoms, respectively. Levels of understanding of HF and its symptoms independently predicted self-care. Compared with patients with complete understanding, those with poor and moderate understanding were more likely to inadequately perform self-care (standardized β=0.24 and 95% CI 3.39-6.48; standardized β=0.12 95% CI 0.53-2.93, respectively). Conclusions: A large minority of patients with HF had poor or moderate understanding of HF and its symptoms. Levels of understanding of HF and its symptoms predicted poor self-care behaviors in these patients. Thus, patient education must be designed to help patients achieve a thorough understanding of the disease and its symptoms to ensure successful self-care among HF patients.

Interactive Digital e-Health Game for Heart Failure Self-Management: A Feasibility Study.

To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology. The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest-post-test design, validated instruments-the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index-were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game. During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information. It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge.

Emerging Role for RBM20 and its Splicing Substrates in Cardiac Function and Heart Failure.

Heart failure is one of the devastating public health problems with high mortality. Among various contributing factors for heart failure, severe dilated cardiomyopathy is the most common indication for cardiac transplantation. Recent evidence revealed that RBM20 mutation represents one main cause for familial dilated cardiomyopathy with a 3% prevalence in all forms of dilated cardiomyopathy. Further scrutiny of molecular mechanisms suggests a role for RBM20 as a functional splicing factor for protein isoform transition, indicating the clinical value of RBM20 mutations in the diagnosis and treatment of heart diseases. RBM20 alternatively splices a set of genes including titin, CaMKIID, and GIT2 at the post transcriptional level to yield diverse isoforms. These target proteins are necessary for cardiac homeostasis including structure and signal transduction. Mutations in RBM20 cause dilated cardiomyopathy along with dysregulated isoform switch. This review aims to summarize the current knowledge of RBM20-related dilated cardiomyopathy and heart failure as well as the underlying mechanism. We will emphasize and thoroughly discuss two splicing targets including titin and CaMKII which are known to play a vital role in dilated cardiomyopathy and heart failure.

16 Hospitalisation with acute heart failure: the patient’s view: results from a qualitative study of the acute heart failure pathway

Unplanned ED visits and admissions are expensive for healthcare systems and often stressful for the patient and family. To improve the use of healthcare resources and the patient experience of care the Global Heart Failure Awareness Programme (HFA of the ESC) emphasises increasing public awareness of the common symptoms of heart failure (HF) and empowering and supporting those with HF to actively engage in their care. This study explored the experiences of patients and GPs. Patients were recruited following an unplanned HF admission to Hospital. The established HF Unit provides monitoring, optimises therapies and provides patient education for 3 months post discharge. We also interviewed General Practitioners (GPs). Data were collected by semi-structured interview and analysed using an inductive, thematic process involving constant comparison. Twenty-four patients were recruited: Mean age of 81 years: 12 (50%) > 80 years: 10 (41%) > 85 years: Male 15 (63%), 9 (37%) de-novo HF, 17 (71%) had more than 3 co-morbidities and 8 (33%) > 3 non-cardiovascular co-morbidities. 11 (46%) lived alone. 6/15 patients with an existing diagnosis of HF had >3 admissions in the past 12 months. Seven GPs took part in the study. Key themes Understanding of HF Patients had a limited understanding of HF. They interpreted their symptoms as related to co-morbid conditions or age: breathlessness due to lung disease: fatigue due to older age. These symptoms did not fit with patient’s views of HF (palpitations or chest pain) or their view of the type of person who developed HF (sedentary lifestyle). This understanding appeared derived from a general knowledge of heart disease portrayed in the media. Continuity of care Patients described a close relationship with their GP that developed from regular monitoring related to comorbidities, on-going medication review, geographical proximity and ease of access. They viewed the GP as a ‘trusted’ source of knowledge. The majority turned to the GP when they sought resolution for symptoms. Following hospital discharge the HFU scheduled face-to-face and telephone follow-up. Patients appreciated the regular contact and were reassured by their monitoring. Fragmentation of care GP’s described barriers to obtaining diagnostic tests. This left them unable to give patients a formal diagnosis or start conversations about HF. Patients described limited access to the HFU for support or information. Some experienced frustration as they attempted to navigate between systems: HFU, GP and ED. Patients in this study were elderly. They had multiple co-morbidities that led to a reliance on the GP. Their limited knowledge of HF resulted in them identifying HF symptoms as related to co-morbid conditions. Fragmentation of care between primary and secondary care were barriers to prompt treatment and to provision of on-going information and supportive resources. These factors contributed to unplanned hospital admission and provided a negative experience of care. These results are now being tested in a larger population and different healthcare organisation.

Factors impacting heart failure patients’ knowledge of heart disease and self-care management

Background: Heart failure (HF) contributes significantly to the morbidity and mortality of the ageing population and is one of the leading causes of re-hospitalization in Singapore. Studies have shown that patient education covering HF and self-care management can lead to greater compliance with treatment regimens, resulting in lower re-hospitalization rates. This study aimed to measure HF patients’ knowledge on the disease and self-care management, and to explore factors influencing their knowledge level. Methods: A questionnaire adapted from the Dutch Heart Failure Knowledge Scale (DHFKS) was completed by 187 patients who were recruited from a tertiary center’s outpatient HF clinic. Data from the survey were analyzed using SPSS (version 22). Results: Knowledge of HF in general had the highest score and that of HF symptoms/recognition of HF symptoms the lowest. The knowledge deficit identified was mainly on therapeutic regimens and HF symptoms/recognition of HF symptoms. The respondents’ knowledge was significantly related to their educational level and whether they had received HF education. Conclusion: For HF patient education to be effective, the program has to be customized to cater to different target groups and individuals. There is a need to develop patient teaching materials and a program with consideration to the patients’ educational levels, demographic, and comorbidity backgrounds.

Cognitive function and health literacy are independently associated with heart failure knowledge

ObjectivesDetermine the relationship between cognitive function and health literacy in heart failure (HF) knowledge in patients with HF. BackgroundHF requires extensive, complex treatment; thus, cognition and health literacy may contribute to understanding and self-management of HF. MethodsParticipants were 330 HF outpatients. Health literacy was assessed using the Medical Term Recognition Test and the Rapid Estimate of Adult Literacy in Medicine. Global cognitive function was screened with the Modified Mini-Mental Status Examination. HF knowledge was assessed with the Dutch Heart Failure Knowledge Scale (DHFKS). ResultsHealth literacy (β = .26, p < .001) and cognition (β = .36, p < .001) were related to DHFKS. Both scores were independently associated with DHFKS (health literacy: β = .13, p = .044 and cognition: β = .30, p < .001). ConclusionsImpairments in health literacy and cognition were independently associated with reduced HF knowledge. Interventions should address both factors to be maximally effective.

Questionnaires Designed to Assess Knowledge of Heart Failure Patients: A Systematic Review.

The objectives of this systematic review were (1) to describe the psychometric properties of questionnaires designed to assess knowledge of heart failure (HF) patients and (2) to identify the most applicable questionnaire to assess knowledge of HF patients. A literature search of electronic databases was conducted from database inception to March 2014. Eligible articles included studies describing the development and psychometric testing of questionnaires designed to assess HF patients' knowledge. Outcomes were based on the quality criteria for measurement properties of health status questionnaires. Articles were considered for inclusion by 2 authors independently. Overall, 12 articles were included, of which 4 (33.33%) were considered "good" quality. Twelve original English-language instruments were identified. Content validity was described in 10 studies and presented positive ratings in all of them (83.33%); internal consistency in 10 studies and positive ratings in 5 (41.66%); construct validity in 5 and positive ratings in 4 (33.33%); responsiveness in 3 and positive ratings in 2 (16.66%); and reproducibility and floor effects in 1 with positive ratings. Based on our criteria, the Atlanta HF Knowledge Test was identified as the most applicable questionnaire to assess knowledge of HF patients. Psychometric properties of questionnaires assessing HF patients' knowledge are poorly described in the literature. Although we identified the Atlanta HF Knowledge Test as the most promising instrument, it has methodological limitations. We recommend the researchers to use the questionnaire that best serves their research question and context.

Validating Eye Tracking as an Objective Assessment Tool in Simulation

BackgroundStandardized, objective measures of performance in a simulated experience are lacking. As eye tracking glasses (ETG) provide video, audio, and data capture of a simulation event and quantitative data of participant actions, this technology is well suited for assessment. Therefore, this study sought to begin validating ETG as an adjunct, objective performance assessment tool in simulation. MethodThis was a prospective, validation study with a two-group, convenience sample of novice and expert nurses who participated in a heart failure (HF) simulation scenario to validate ETG using a known-groups approach. A HF scenario designed to elicit seven basic nursing tasks was followed by a knowledge test and demographic questionnaire. ResultsThe groups were equivalent in basic HF knowledge as related to the care of a dyspneic patient. Of the seven tasks, all novices completed only one, while in the expert group, all participants completed four of the seven. Significance was found between groups for time to task in five of seven tasks and eye fixation times in key areas. ConclusionsThis pilot study begins the validation process of ETG technology as an objective assessment method as significant differences were elicited between known groups. ETG technology also provides meaningful data and visual images that can be used to inform nursing education in simulation. Additional research is needed to further establish the validity and reliability of ETG technology as an assessment tool in clinical simulation.

Sodium Knowledge and Skills Index for Heart Failure (SKASI-HF): Instrument Development and Analysis

The purpose of this research was to develop a valid and reliable tool that can be widely used in both the clinical and research settings to measure the sodium knowledge and skills of heart failure (HF) patients and their support persons.

Improving Home Health Staff Knowledge of Heart Failure

Heart Failure (HF) affects millions of people in the United States and is the most frequent cause of 30 day rehospitalization. Use of home health (HH) services has been found to be a strong predictor for readmission risk, and many rehospitalizations of HF patients that utilize HH services are considered potentially avoidable. Educational programs which include topics such as HF risk factors, drug therapy, patient self management of HF, and recognition of acute HF can improve nurses knowledge.

Evaluating a Web-Based Self-Management Intervention in Heart Failure Patients: A Pilot Study.

BackgroundWeb-based interventions may have the potential to support self-care in patients with chronic disease, yet little is known about the feasibility of Web-based interventions in patients with heart failure (HF).ObjectiveThe objective of our study was to develop and pilot a Web-based self-care intervention for patients with HF.MethodsFollowing development and pretesting, we pilot tested a Web-based self-care intervention using a randomized controlled design. A total of 28 participants completed validated measures of HF knowledge, self-care, and self-efficacy at baseline and 1-month follow-up.ResultsChange scores and effect size estimates showed that the mean differences in HF knowledge (d=0.06), self-care (d=0.32), and self-efficacy (d=0.37) were small. Despite email reminders, 7 of 14 participants (50%) of the sample accessed the site daily and 4 of 14 (28%) had no record of access.ConclusionsLarger randomized controlled trials are needed that attend to all sources of self-efficacy and include more comprehensive educational tools to improve patient outcomes.

(361) - Correlation of GDF-15 with Worsening Functional Capacity and Echocardiographic Parameters in Idiopathic Dilated Cardiomyopathy

s S141 and August 2015. We measured HL using the Newest Vital Sign tool, disease knowledge with the validated English-version Dutch Heart Failure Knowledge Scale, and self-care with the validated Self-Care Heart Failure Index. Results: The sample was predominantly male (72.6%) with an average age of 56.6 years. 43 (32%) had low HL (28/90 in HF; 15/45 in VAD/HTx). Patients with low HL were significantly older (61.3 vs 54.4 years; p 0.1). HF patients with low HL also trended towards poorer self-care maintenance (71.48% vs 78.36%, p= 0.06) and self-care confidence (67.71% vs 75.42%, p= 0.06) but these did not reach statistical significance. Neither self-care maintenance (79.48% vs 81.03%; p> 0.5), nor confidence (75.99% vs 78.21%, p> 0.5) was associated with low HL in the VAD/HTx group. Conclusion: This study found that 32% of patients with HF or VAD/HTx have low HL. This population is characterized by increased age, less formal education, and English as a second language. In HF patients, low HL is associated with poorer HF knowledge and self-care, which may negatively impact outcomes. Despite this effect of low HL in the HF population, in VAD/ HTx patients, low HL does not appear to correlate with HF knowledge or self-care. Low HL represents a marker for patients who may benefit from additional educational supports.

Development and Validation of a Heart Failure-Specific Health Literacy Scale.

Health literacy (HL) is an important concept for patient education and disease management with heart failure (HF). However, research on HL has predominantly focused on functional HL (ability to read and write). The World Health Organization advocates evaluating comprehensive HL, including the ability to access information (communicative HL) and critically evaluate that information (critical HL). We developed an instrument for measuring functional, communicative, and critical levels of HL in patients with HF. We evaluated the reliability and validity of those 3 HL scales in a sample of 191 outpatients with HF (mean [SD] age, 66.9 [13.9] years; 64.9% males). Sociodemographic and clinical characteristics, knowledge of HF, a well as motivation to obtain health information were assessed for each patient through a self-administered questionnaire and review of electronic medical records. We constructed scale items to reflect directly the comprehensive World Health Organization definition of HL. We identified 3 interpretable factors by exploratory factor analysis. Internal consistency was marginally acceptable for total HL (Cronbach α = 0.71), functional HL (α = 0.73), communicative HL (α = 0.68), and critical HL (α = 0.69); the interclass correlation coefficients of the functional, communicative, and critical HL subscales were 0.882, 0.898, and 0.882, respectively. Low functional, communicative, and critical HL was characteristic of older patients, those with lower socioeconomic status, patients living alone, those without a high school education, and patients lacking HF knowledge. Our new HL scale was demonstrated to be a reliable, valid instrument for measuring functional, communicative, and critical HL in patients with HF. Exploring a patient's HL level, including the ability to access, understand, and use health information as well as the ability to read and write, may provide better understanding of patients' potential barriers to self-care.

Health Literacy and Heart Failure: A Systematic Review.

Low health literacy affects millions of Americans, putting those who are affected at a disadvantage and at risk for poorer health outcomes. Low health literacy can act as a barrier to effective disease self-management; this is especially true for chronic diseases such as heart failure (HF) that require complicated self-care regimens. This systematic review examined quantitative research literature published between 1999 and 2014 to explore the role of health literacy among HF patients. The specific aims of the systematic review are to (1) describe the prevalence of low health literacy among HF patients, (2) explore the predictors of low health literacy among HF patients, and (3) discuss the relationship between health literacy and HF self-care and common HF outcomes. A systematic search of the following databases was conducted, PubMed, CINAHL Plus, Embase, PsycINFO, and Scopus, using relevant keywords and clear inclusion and exclusion criteria. An average of 39% of HF patients have low health literacy. Age, race/ethnicity, years of education, and cognitive function are predictors of health literacy. In addition, adequate health literacy is consistently correlated with higher HF knowledge and higher salt knowledge. Considering the prevalence of low health literacy among in the HF population, nurses and healthcare professionals need to recognize the consequences of low health literacy and adopt strategies that could minimize its detrimental effect on the patient's health outcomes.

How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study

BackgroundAlthough the effectiveness of heart failure (HF) disease management programs has been established in Western countries, to date there have been no such programs in Japan. These programs may have different effectiveness due to differences in health care organization and possible cultural differences with regard to self-care. Therefore, the purpose of this study was to evaluate the effectiveness of a pilot HF program in a Japanese setting.MethodsWe developed an HF program focused on enhancing patient self-care before hospital discharge. Patients were randomized 1:1 to receive the new HF program or usual care. The primary outcome was self-care behavior as assessed by the European Heart Failure Self-Care Behavior Scale (EHFScBS). Secondary outcomes included HF knowledge and the 2-year rate of HF hospitalization and/or cardiac death.ResultsA total of 32 patients were enrolled (mean age, 63 years; 31% female). There was no difference in the total score of the EHFScBS between the two groups. One specific behavior score regarding a low-salt diet significantly improved compared with baseline in the intervention group. HF knowledge in the intervention group tended to improve more over 6 months than in the control group (a group-by-time effect, F=2.47, P=0.098). During a 2-year follow-up, the HF program was related to better outcomes regarding HF hospitalization and/or cardiac death (14% vs 48%, log-rank test P=0.04). In Cox regression analysis after adjustment for age, sex, and logarithmic of B-type natriuretic peptide, the program was associated with a reduction in HF hospitalization and/or cardiac death (hazard ratio, 0.17; 95% confidence interval, 0.03–0.90; P=0.04).ConclusionThe HF program was likely to increase patients’ HF knowledge, change their behavior regarding a low-salt diet, and reduce HF hospitalization and/or cardiac events. Further improvement focused on the transition of knowledge to self-care behavior is necessary.

Abstract 16329: Multimorbidity and Quality of Life in Heart Failure Patients With Poor Self-care Behavior

Introduction: Multimorbidity, the co-occurrence of various chronic conditions, is of major concern in patients with heart failure (HF) because it is associated with impaired quality of life (QOL) and adverse outcomes. Effective self-care is an essential adjunct to evidence-based medical treatment aimed at delaying progression of HF. Hypothesis: This study investigated the relationships between multimorbidity, QOL and level of self-care in HF patients. Methods: Study subjects completed questionnaires on HF-related quality of life (Minnesota Living with Heart Failure questionnaire), HF-related self-care behaviors (European Heart Failure Self-Care Behavior Scale), HF-related knowledge (Japanese heart failure knowledge scale) and depression symptoms. Comorbidities and other clinical and social characteristics were also assessed. Analyses of covariance and multivariate linear regression were used to assess associations between multimorbidity and QOL. Results: A total of 231 outpatients with HF were assessed; 119 with poor self-care (self-care score&lt; 34) and 112 with adequate self-care (self-care score≥34); mean age 65.8 ± 13.9 and 69.8 ± 13.7 years, respectively. Of these patients, 57.6% had three or more additional chronic conditions; the most prevalent being hypertension (56.0%) and chronic kidney disease (46.6%). Patients with multimorbidity had worse QOL than patients without (P &lt; 0.01). Subjects with poor self-care and multimorbidity had worse QOL than those without multimorbidity (P &lt; 0.01); however, there was no association between multimorbidity and QOL in patients with adequate self-care. Multivariate analysis controlling for the effects of other variables showed that multimorbidity was an independent determinant of QOL overall and in poor self-care patients (sβ = 0.15, P = 0.04; sβ = 0.28, P &lt; 0.01, respectively). However, in patients with adequate self-care, multimorbidity was not associated with QOL. Conclusions: Multimorbidity is an independent determinant of QOL in HF patients with poor self-care. To improve their QOL, both reinforcement of adequate self-care behavior regarding their HF and a multidimensional approach to enhancing self-management of their comorbidities are needed.

Structured telephone support or non-invasive telemonitoring for patients with heart failure.

Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness.To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care.We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits.We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up.We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age).We include 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.Non-invasive telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I² = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I² = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I² = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I² = 27%, GRADE: moderate-quality evidence).Neither structured telephone support nor telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I² = 47%, GRADE: very low-quality evidence; non-invasive telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I² = 71%, GRADE: very low-quality evidence).Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one telemonitoring study reported a decrease in costs and two telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medical management. Adherence was rated between 55.1% and 98.5% for those structured telephone support and telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours.For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care.<b> </b>The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients. By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.