Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
BMC Cardiovasc Disord. 2014 Jan 31;14:12. doi: 10.1186/1471-2261-14-12.
Weight monitoring is an important element of HF self-care, yet the most clinically meaningful way to evaluate weight monitoring adherence is uncertain. We conducted this study to evaluate the association of (1) self-reported recall and (2) daily diary-recorded weight monitoring adherence with heart failure-related (HF-related) hospitalization.
We conducted a prospective cohort study among 216 patients within a randomized trial of HF self-care training. All patients had an initial self-care training session followed by 15 calls (median) to reinforce educational material; patients were also given digital scales, instructed to weigh daily, record weights in a diary, and mail diaries back monthly. Weight monitoring adherence was assessed with a self-reported recall question administered at 12 months and dichotomized into at least daily versus less frequent weighing. Diary-recorded weight monitoring was evaluated over 12 months and dichotomized into ≥80% and <80% adherence. HF-related hospitalizations were ascertained through patient report and confirmed through record review.
Over 12 months in 216 patients, we identified 50 HF-related hospitalizations. Patients self-reporting daily or more frequent weight monitoring had an incidence rate ratio of 1.34 (95% CI 0.24-7.32) for HF-related hospitalizations compared to those reporting less frequent weight monitoring. Patients who completed ≥80% of weight diaries had an IRR of 0.37 (95% CI 0.18-0.75) for HF-related hospitalizations compared to patients who completed <80% of weight diaries.
Self-reported recall of weight monitoring adherence was not associated with fewer HF hospitalizations. In contrast, diary-recorded adherence ≥80% of days was associated with fewer HF-related hospitalizations. Incorporating diary-based measures of weight monitoring adherence into HF self-care training programs may help to identify patients at risk for HF-related hospitalizations.
体重监测是心力衰竭自我护理的一个重要组成部分，但评估体重监测依从性的最有临床意义的方法尚不确定。我们进行这项研究，旨在评估（1）自我报告的回忆和（2）每日日记记录的体重监测依从性与心力衰竭相关（HF 相关）住院之间的关系。
我们在一项心力衰竭自我护理培训的随机试验中进行了一项前瞻性队列研究。所有患者均接受初始自我护理培训课程，随后接受 15 次（中位数）电话随访以强化教育材料；还为患者提供了电子秤，指导他们每天称重，将体重记录在日记中，并每月邮寄回日记。体重监测依从性通过在 12 个月时进行的自我报告回忆问题进行评估，并分为至少每日称重与不频繁称重。评估 12 个月的日记记录体重监测情况，并分为≥80%和<80%的依从性。通过患者报告和记录审查确定 HF 相关住院情况。
在 216 名患者中，我们在 12 个月内确定了 50 例 HF 相关住院。与报告不频繁称重的患者相比，自我报告每日或更频繁称重的患者 HF 相关住院的发生率比为 1.34（95%CI 0.24-7.32）。完成≥80%体重日记的患者 HF 相关住院的 IRR 为 0.37（95%CI 0.18-0.75），而完成<80%体重日记的患者为 0.37（95%CI 0.18-0.75）。
自我报告的体重监测依从性回忆与 HF 住院次数减少无关。相比之下，日记记录的≥80%天数的依从性与 HF 相关住院次数减少有关。将基于日记的体重监测依从性测量纳入心力衰竭自我护理培训计划可能有助于识别 HF 相关住院的风险患者。
