Abstract 2235: Promoting Self-Management in Heart Failure Patients through Education and Telemonitoring
In order to reduce the impact of HF through reductions in hospitalizations and improvement in quality of life, early detection of progressing HF symptoms and nursing education on self-monitoring and management are critical. Home telemonitoring (TM) systems are gaining attention as a method to monitor health more frequently and promote self-management. Thus far research on TM has primarily focused on non-patient centered outcomes. The purpose of the study was to compare self-management practices of telemonitored HF patients on admission to home care and at 9-weeks. A prospective design was used to study 19 HF patients recruited from a home care agency in the Midwest. The TM unit was placed in the home within 48 hours of admission. Physiologic and subjective data were transmitted to a central station daily. The subjects were administered the Self-Care of Heart Failure Index (SCHFI) on admission to home care and again at 9-weeks. The SCHFI measures self-care maintenance, management, and confidence in a 15 item questionnaire. Comparisons of the SCHFI scores were analyzed with paired sample t-tests. Nineteen patients with HF receiving home care and TM services were enrolled (9 males). The mean age was 83.9 years, NYHA class III (68.4%), ejection fraction 38.3%, and mean monitoring time of 34 days. Scores at admission and 9-weeks were highest for the self-care maintenance subscale and lowest for management (80.28 ±11.91/94.49 ±5.91; 62.85 ±22.93/73.02 ±15.29). A significant improvement in the 9-week self-care maintenance and self-care confidence scores were seen when compared to the admission SCHFI scores (P<.009, P<.05, CI 95%). No significant difference was found for the self-care management scores, although the 9-week scores were improved (62.85 ±22.93/73.01 ±15.29). This study expands our understanding of the usefulness of TM to promote self-management in persons with HF. All self-care subscales demonstrated improvement from admission to 9 weeks and indicates that TM may have an active rather than a perceived passive role in the development of self-management. The self-care management subscale had the lowest mean overall and the least improvement over time and indicates a specific area to target nursing interventions for HF patient education and TM practices.