Lycholip Edita, Thon Aamodt Ina, Lie Irene, Šimbelytė Toma, Puronaitė Roma, Hillege Hans, de Vries Arjen, Kraai Imke, Stromberg Anna, Jaarsma Tiny, Čelutkienė Jelena
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,
Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania,
Patient Prefer Adherence. 2018 Jun 26;12:1113-1122. doi: 10.2147/PPA.S162219. eCollection 2018.
Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited.
This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care.
In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69±11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ).
The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, =0.023). Self-care behavior improved in the ICT-guided-DMS group (<0.01) but not in the TM+ICT-guided-DMS group. Factors associated with self-care worsening were as follows: higher physical subscale of MLHFQ (per 10 points, <0.05), lower left ventricular ejection fraction (LVEF) (per 5%, <0.05), lower New York Heart Association (NYHA) class (class III vs class II, <0.05). The subgroups of patients who had an initial EHFScBs total score >28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score ≤8, demonstrated the greatest potential to improve self-care during the study.
TM did not have an advantage on self-care improvement. Poor physical aspect of quality of life, lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression.
自我护理是心力衰竭（HF）患者重要的患者报告结局（PRO），可能会受到疾病管理和/或远程监测（TM）的影响。报告TM对自我护理影响的研究数量有限。
本研究旨在：评估除信息通信技术（ICT）引导的疾病管理系统（ICT引导的DMS）外，TM是否会影响自我护理行为；评估研究期间自我护理的动态变化；调查导致自我护理变化的因素；并确定使患者易于改善自我护理的患者特征。
在慢性HF患者门诊创新ICT引导DMS联合远程监测（IN TOUCH）研究中，177例患者被随机分为ICT引导的DMS组或TM + ICT引导的DMS组，随访9个月。当前分析纳入了118名参与者（平均年龄：69±11.5岁；70%为男性），他们填写了以下PRO工具：九项欧洲心力衰竭自我护理行为量表（EHFScBs）、医院焦虑抑郁量表（HADs）和明尼苏达心力衰竭生活问卷（MLHFQ）。
与ICT引导的DMS组（n = 60，P = 0.023）相比，TM + ICT引导的DMS组（n = 58）的自我护理基线水平更好。ICT引导的DMS组的自我护理行为有所改善（P < 0.01），但TM + ICT引导的DMS组没有。与自我护理恶化相关的因素如下：MLHFQ身体亚量表得分较高（每10分，P < 0.05）、左心室射血分数（LVEF）较低（每5%，P < 0.05）、纽约心脏协会（NYHA）分级较低（III级与II级相比，P < 0.05）。初始EHFScBs总分>28或17至28分且伴有HADs抑郁亚量表（HADs_D）得分≤8的患者亚组，在研究期间显示出最大的自我护理改善潜力。
TM在改善自我护理方面没有优势。生活质量的身体方面较差、LVEF较低和NYHA分级较低与自我护理恶化相关。在那些初始自我护理水平低或中等且无抑郁的患者中，可能实现最大程度的自我护理改善。
