The long range plan for this applicant is to develop a program of research centered on testing interventions to improve outcomes in cardiovascular patients and inform policy development through the contribution of cost effectiveness data. This proposed pilot study of an educational and behavioral intervention EBI plans to assess the feasibility and determine the effect size on outcomes of fluid volume status and cost effectiveness in adults with heart failure. Despite numerous pharmacologic and technologic advances in the treatment of HF in the past 20 years, health care utilization and costs continue to rise while outcomes for this population have minimally improved. One hypothesis regarding this failure to improve outcomes is that there is poor adherence by persons with HF to prescribed lifestyle changes.
The specific aims are: To examine the incremental effect of an EBI on volume status in persons with heart failure HF in comparison to an education only EO control group at 3 months; to examine the effect of an EBI on outcomes of health resource utilization HRU, costs, and quality of life at baseline, 3 and 6 months; and to explore trends in the incremental cost-effectiveness of the EBI by comparing the costs and outcomes of the EBI group to those of the EO group for the 6 months under study. Adult persons with HF and implantable intrathoracic impedance monitoring MM device will be randomized in this experimental design to the EBI or EO groups. Supporting the mission of NINR, the conceptual framework guiding this intervention proposes to improve quality of life and adherence through self-management. Outcomes that will be assessed include the self-management behavior by the patient three day food and fluid diary, 24-hour urine collection for sodium, and a daily weight and fluid intake log; physiologic measures of fluid congestion MM, b-natriuretic peptide, and the congestion score; patient reported symptom distress Thirst Distress Scale and the Heart Failure Symptom Survey; health resource utilization; and quality of life EuroQol. Both intermediate and final cost-effectiveness analyses will be conducted. The relevance of this research lies in the overwhelming statistics that 5 million Americans have been diagnosed with HF and the Medicare program spent more money on the diagnosis and treatment of HF than any other single illness. The educational and behavioral intervention proposed is intended to improve adherence to one particularly challenging lifestyle modification, the fluid restriction. By providing strategies to limit the symptom distress of a fluid restriction, it is believed that adherence will be greater leading to improved quality of life and that it will be cost-effective through decreased hospitalizations. ? ? ?
| Butts, Brittany; Higgins, Melinda; Dunbar, Sandra et al. (2018) The Third Time's a Charm: Psychometric Testing and Update of the Atlanta Heart Failure Knowledge Test. J Cardiovasc Nurs 33:13-21 |
| Reilly, Carolyn Miller; Higgins, Melinda; Smith, Andrew et al. (2015) Single subject design: Use of time series analyses in a small cohort to understand adherence with a prescribed fluid restriction. Appl Nurs Res 28:356-65 |
| Reilly, Carolyn Miller; Higgins, Melinda; Smith, Andrew et al. (2015) Isolating the benefits of fluid restriction in patients with heart failure: A pilot study. Eur J Cardiovasc Nurs 14:495-505 |
