Self-management Counseling in Patients With Heart Failure The Heart Failure Adherence and Retention Randomized Behavioral Trial
Self-management Counseling in Patients With Heart Failure The Heart Failure Adherence and Retention Randomized Behavioral Trial
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DOI：
10.1001/jama.2010.1362
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发表时间：
2010-09-22
影响因子：
120.7
通讯作者：
Avery, Elizabeth
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文献类型：
--
作者：
Powell, Lynda H.;Calvin, James E., Jr.;Avery, Elizabeth
背景激励心力衰竭患者坚持医嘱并没有转化为临床获益，但过去的试验有方法学上的局限性。目的确定自我管理咨询加心力衰竭教育与单纯心力衰竭教育相比，在死亡或心力衰竭住院治疗的主要终点方面的价值。设计、设置和患者心力衰竭依从性和保留试验（哈特），一项单中心、多医院、部分设盲的行为疗效随机对照试验，涉及902例轻度至中度心力衰竭和收缩功能降低或保留的患者，在2001年10月至2004年10月期间从芝加哥大都市区随机抽取，并进行以下研究-在1年的过程中，向所有患者提供18个联系人和18个心力衰竭教育提示表。随机分配到教育组的患者通过邮件和电话收到提示信息，以检查理解情况。被随机分配到自我管理组的患者接受分组提示表，并被教授自我管理技能以实施Advisory.Main Outcome Measure在中位数为2.56年的随访期间死亡或心力衰竭住院。（平均年龄63.6岁; 47%为女性，40%为少数民族，52%的家庭年收入低于30000美元，23%的收缩功能正常）。自我管理组的主要终点发生率与教育组无差异（分别为163 [40.1%] vs 171 [41.2%];比值比，0.95 [95%置信区间，0.72-1.26]）。有没有显着差异的任何次要终点，包括死亡，心力衰竭住院，全因住院，或quality of life.Conclusions相比，加强教育干预单独，除了自我管理咨询并没有减少死亡或心力衰竭住院轻中度心力衰竭患者。
Context Motivating patients with heart failure to adhere to medical advice has not translated into clinical benefit, but past trials have had methodological limitations.Objective To determine the value of self-management counseling plus heart failure education, compared with heart failure education alone, for the primary end point of death or heart failure hospitalization.Design, Setting, and Patients The Heart Failure Adherence and Retention Trial (HART), a single-center, multiple-hospital, partially blinded behavioral efficacy randomized controlled trial involving 902 patients with mild to moderate heart failure and reduced or preserved systolic function, randomized from the Chicago metropolitan area between October 2001 and October 2004 and undergoing follow-up for 2 to 3 subsequent years.Interventions All patients were offered 18 contacts and 18 heart failure educational tip sheets during the course of 1 year. Patients randomized to the education group received tip sheets in the mail and telephone calls to check comprehension. Patients randomized to the self-management group received tip sheets in groups and were taught self-management skills to implement the advice.Main Outcome Measure Death or heart failure hospitalization during a median of 2.56 years of follow-up.Results Patients were representative of typical clinical populations (mean age, 63.6 years; 47% women, 40% racial/ethnic minority, 52% with annual family income less than $30 000, and 23% with preserved systolic function). The rate of the primary end point in the self-management group was no different from that in the education group (163 [40.1%)] vs 171 [41.2%], respectively; odds ratio, 0.95 [95% confidence interval, 0.72-1.26]). There were no significant differences on any secondary end points, including death, heart failure hospitalization, all-cause hospitalization, or quality of life.Conclusions Compared with an enhanced educational intervention alone, the addition of self-management counseling did not reduce death or heart failure hospitalization in patients with mild to moderate heart failure.