Stut Wim, Deighan Carolyn, Cleland John G, Jaarsma Tiny
Philips Research Europe, Eindhoven, the Netherlands.
The Heart Manual Department, NHS Lothian, Edinburgh, UK.
Patient Prefer Adherence. 2015 Aug 19;9:1195-206. doi: 10.2147/PPA.S88482. eCollection 2015.
The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient.
The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days) admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA) Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system's database.
Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101) improved during the study for daily weighing, low-salt diet, physical activity (P<0.001), and fluid restriction (P<0.05). Average adherence (n=120) to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%.
Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was high and remained stable over time. However, adherence to daily reporting of symptoms was lower and declined in the long-term.
本研究旨在评估一项新型在线教育与辅导项目，以促进心力衰竭患者的自我护理。在该项目中，教育和辅导内容会根据患者的知识水平和行为自动进行调整。
该项目的评估是在“心脏周期”研究范围内进行的。这项多中心观察性研究考察了第三代远程医疗系统增强对近期（<60天）因心力衰竭加重入院患者或纽约心脏协会（NYHA）功能分级为III/IV级的持续性症状门诊患者管理的能力。通过9项欧洲心力衰竭自我护理行为量表在基线和研究结束时评估自我报告的自我护理行为。通过分析系统数据库确定每日称重、血压监测及症状报告的依从性。
在纳入的123例患者中，平均年龄为66±12岁，66%为NYHA III级，79%为男性。在研究期间，自我报告的自我护理行为评分（n = 101）在每日称重、低盐饮食、体育活动（P<0.001）和液体限制（P<0.05）方面有所改善。测量体重的平均依从性（n = 120）为90%±16%，测量血压的依从性为89%±17%，症状报告的依从性为66%±32%。
在观察期内，自我报告的自我护理行为评分显著改善，每日体重和血压测量的依从性客观证据较高且随时间保持稳定。然而，每日症状报告的依从性较低且长期呈下降趋势。
