Self-Management of Early Stage Heart Failure

Univ Of Massachusetts Med Sch Worcester, Worcester MA

Investigators

Abstract

DESCRIPTION (PROVIDED BY APPLICANT: Heart failure (HF) is a significant public health problem in the United States, particularly among the elderly. Adherence to evidence-based treatment and management guidelines requires continual compliance with multiple proven pharmacologic and behavioral regimens, which can be challenging. HF is a progressive disease, and appropriate management at early stages could improve health outcomes. Intervention studies to date, however, have largely focused on persons with moderate and advanced disease. To improve secondary prevention among early stage patients and decrease disease progression, effective strategies need to be developed to improve evidence-based practice and guideline adherence in real world settings. Early stage HF, however, poses research challenges because it can be difficult to diagnose, difficult to motivate patients who are mildly symptomatic to change multiple behaviors, and because patients are largely monitored through overburdened primary care systems. Tailored intervention protocols need to be developed and pilot tested. We propose to pilot test a patient-centered, nurse practitioner-delivered intervention, developed under the framework of the Chronic Care Model, targeting early stage HF patients managed within primary care settings. The pilot will be conducted at a large academic medical center and a community affiliated practice site. The tailored intervention uses a patient-centered counseling approach, largely informed by Social Cognitive Theory, which consists of: 1) an in-person Self-Management Planning Session (SMPS) with a Nurse Practitioner (NP), and 2) five Telephone Reinforcement Sessions (TRS) with the NP. The purpose of the SMPS is to engage the patient in an interactive session with the NP which includes HF education, the identification of individual self-management needs, the identification of barriers to appropriate self-management, and the development of self-management goals and an action plan to address barriers. TRS will be tailored, based on the needs, barriers, goals and action plan identified in the SMPS and are intended to assess progress, re-evaluate goals and make additional goals and plans as necessary. Central to the intervention is the inclusion of a well-formulated, systematic communication process between the NP and the PCP. The intervention will be pilot tested on 20 early stage HF patients. A well designed process evaluation plan has been designed to assess the feasibility of implementing a subsequent effectiveness trial, assess patient receptivity to the strategy, assess PCP receptivity to the strategy and utility of the NP communication system, and test and refine measurement tools. Upon completion, the intervention strategy will be refined for the purpose of testing its effectiveness in a randomized controlled trial.