Heart failure is one of the few cardiovascular conditions that is increasing in prevalence. It is a chronic illness that progresses to increasing functional decline, repeated hospitalizations, and placement in long-term care, all of which result in considerable health care expenditures. Progression can be slowed by drug therapy and lifestyle modifications, but non-adherence to these treatment recommendations has been high, approaching 90 percent in some populations. Self-management (SM) interventions are becoming increasingly popular as a treatment for chronic illness but they have not yet been directed specifically to the problem of heart failure. These interventions are distinguished by their focus on activating the patient to take responsibility for the behavioral side of the illness, and developing self-efficacy in this role by teaching SM skills that are basic to making needed lifestyle changes. This is a single-site, partially blinded, randomized clinical trial of 900 patients with systolic or diastolic dysfunction and NYHA functional class II, or III. They will be recruited over a period of 2 years using 7 hospitals. Patients randomized to SM intervention or an attention control and will meet 18 times, for 1.5 hours, over 1 year. These sessions will teach patients how to use 5 basic self-management skills (self-monitoring, environmental restructuring, social support, cognitive restructuring, and the relaxation response) to help them build self-efficacy and maintaining it after the treatment has been discontinued. The attention control intervention will consist of a didactic lecture series about medical topics and heart failure. Treatment effects will be evaluated using the primary outcome of hospitalization for heart failure or death, and the secondary outcomes of progression of heart failure, quality of life, and health care costs. Potential mediators of effectiveness include improved adherence and improved psychosocial function.
