Dunbar Sandra B, Reilly Carolyn M, Gary Rebecca, Higgins Melinda K, Culler Steven, Butts Brittany, Butler Javed
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
J Card Fail. 2015 Sep;21(9):719-29. doi: 10.1016/j.cardfail.2015.05.012. Epub 2015 May 29.
Persons with concomitant heart failure (HF) and diabetes mellitus (DM) have complicated, often competing, self-care expectations and treatment regimens that may reduce quality of life (QOL). This randomized controlled trial tested an integrated self-care intervention on outcomes of HF and DM QOL, physical function, and physical activity (PA).
Participants with HF and DM (n = 134; mean age 57.4 ± 11 years, 66% men, 69% minority) were randomized to usual care (control) or intervention. The control group received standard HF and DM educational brochures with follow-up telephone contact. The intervention group received education and counseling on combined HF and DM self-care (diet, medications, self-monitoring, symptoms, and PA) with follow-up home visit and telephone counseling. Measures included questionnaires for HF- and DM-specific and overall QOL, PA frequency, and physical function (6-min walk test [6MWT]) and were obtained at baseline and 3 and 6 months. Analysis included mixed models with a priori post hoc tests. Adjusting for age, body mass index, and comorbidity, the intervention group improved in HF total (P = .002) and physical (P < .001) QOL scores at 3 months with retention of improvements at 6 months, improved in emotional QOL scores compared with control at 3 months (P = .04), and improved in health status ratings (P = .04) at 6 months compared with baseline. The intervention group improved in 6MWT distance (924 ft to 952 ft; P = .03) whereas the control group declined (834 ft to 775 ft; F1,63 = 6.86; P = .01). The intervention group increased self-reported PA between baseline and 6 months (P = .01).
An integrated HF and DM self-care intervention improved perceived HF and general QOL but not DM QOL. Improved physical functioning and self-reported PA were also observed with the integrated self-care intervention. Further study of the HF and DM integrated self-care intervention on other outcomes, such as hospitalization and cost, is warranted.
合并心力衰竭（HF）和糖尿病（DM）的患者有着复杂且往往相互冲突的自我护理期望和治疗方案，这可能会降低生活质量（QOL）。这项随机对照试验测试了一种综合自我护理干预措施对HF和DM患者生活质量、身体功能及身体活动（PA）的影响。
患有HF和DM的参与者（n = 134；平均年龄57.4±11岁，66%为男性，69%为少数族裔）被随机分为常规护理组（对照组）或干预组。对照组收到标准的HF和DM教育手册，并通过电话进行随访。干预组接受关于HF和DM综合自我护理（饮食、药物、自我监测、症状和PA）的教育和咨询，并进行家庭随访和电话咨询。测量指标包括针对HF和DM的特定问卷以及总体生活质量问卷、PA频率和身体功能（6分钟步行试验[6MWT]），在基线、3个月和6个月时进行测量。分析采用混合模型及先验事后检验。在调整年龄、体重指数和合并症后，干预组在3个月时HF总体（P = 0.002）和身体（P < 0.001）生活质量得分有所改善，6个月时仍保持改善；与对照组相比，干预组在3个月时情绪生活质量得分有所改善（P = 0.04），在6个月时健康状况评分与基线相比有所改善（P = 0.04）。干预组6MWT距离有所增加（从924英尺增至952英尺；P = 0.03），而对照组则下降（从834英尺降至775英尺；F1,63 = 6.86；P = 0.01）。干预组在基线至6个月期间自我报告的PA有所增加（P = 0.01）。
HF和DM综合自我护理干预改善了患者对HF的感知及总体生活质量，但未改善DM生活质量。综合自我护理干预还改善了身体功能和自我报告的PA。有必要进一步研究HF和DM综合自我护理干预对其他结局（如住院率和费用）的影响。
