Efficacy of a Self-Monitoring Traffic Light Diary on Outcomes of Patients With Heart Failure: A Randomized Controlled Trial Publisher Pubmed



Nomali M^{1, 2, 3} ; Mohammadrezaei R^{4, 5} ; Yaseri M¹ ; Tayebi A⁶ ; Ayati A⁵ ; Roshandel G⁷ ; Keshtkar A⁸ ; Ghiyasvandian S⁹ ; Alipasandi K¹⁰ ; Navid H^{4, 5} ; Zakerimoghadam M⁹
Source: International Journal of Nursing Studies Published:2024

Abstract

Background and objective: Patients with heart failure experience high hospitalization. However, patients cannot recognize symptoms according to current approaches, which needs to be improved by new self-monitoring instruments and strategies. Thus, we aimed to assess a self-monitoring traffic light diary on outcomes of patients with heart failure. Methods: This was a single-blind, two-arm parallel group randomized controlled trial at the heart failure clinic of Tehran Heart Center (Tehran, Iran). Adult patients with a definitive diagnosis of heart failure with reduced ejection fraction (i.e., ejection fraction of less than 40 %), and New York Heart Association functional classes II–IV were included. A block-balanced randomization method was used to assign eligible subjects to the intervention or control group. Baseline data were collected before random allocation. Participants in the intervention group received a comprehensive intervention consisting of (1) self-care education by an Australian Heart Foundation booklet on heart failure, (2) regular self-monitoring of weight and shortness of breath at home, and (3) scheduled call follow-ups for three months. Patients in the control group received usual care. The primary outcome was heart failure self-care; the secondary outcomes were heart failure quality of life, knowledge, and all-cause hospitalization. Results: From June to August 2017, 68 patients were included in the study. The overall age of participants was 55 (13.6) years old, and 71 % of patients were male. A significant association between the intervention and self-care maintenance (β 5.1; 95 % CI 2.50 to 7.70, P < 0.001), self-care management (β 10.6; 95 % CI 6.50 to 14.8, P < 0.001), self-care confidence (β 8.0; 95 % CI 5.0 to 11.0, P < 0.001) and heart failure knowledge (β 1.7; 95 % CI 1.30, 2.04; P < 0.001) was found. However, there was no association between the intervention and quality of life (β 2.5; 95 % CI − 0.79, 5.88, P 0.135) and hospitalization-free survival of the two groups (Log-Rank P 0.540). Conclusion: A self-monitoring traffic light diary can improve self-care behaviors and heart failure knowledge in patients with heart failure with reduced ejection fraction. RCT approval ID: Iranian Registry of Clinical Trials IRCT2017021032476N1. Study protocol: PMCID: PMC6262204. © 2024 Elsevier Ltd