Abstract 1416: Family Partnership and Education Interventions Reduce Dietary Sodium Intake by Patients With Heart Failure
Purpose: Lowering dietary sodium by persons with heart failure (HF) is difficult and most often occurs within the home and family context. We hypothesized that a HF family partnership intervention (FPI) would have an incremental effect over structured patient and family education (PFE) and usual care (UC) on reducing dietary sodium by NYHA Class II and III patients.
Method: HF patients and a family member (FM) (n=117 dyads) were randomized to receive PFE, PFE plus FPI or UC. PFE included indepth education on diet selection and preparation, label reading and low sodium foods. FPI added knowledge and skills of family support communication, collaboration, and empathy using autonomy support concepts. HF subjects were 64% male, mean age 56±10 years; left ventricular ejection fraction 26.9±13%, 58% African American, with optimal HF medications prescribed. FMs were 81% female, mean age of 52±13 years, and 53% spouses. Dietary sodium intake was measured by 24 hour urinary sodium (Urine NA) and a three-day food record analyzed with a nutrient software program (Diet NA) at baseline (BL), 4 and 8 months (M). Analyses included descriptive statistics, ANOVA adjusted for age, body mass index and NYHA class contrasted by group and time, and Chi square analysis.
Results: At BL, groups did not differ on demographic, clinical or Diet or Urine NA variables. At 4 M, FPI group had decreased mean Urine NA from BL (3754±1854 to 3001±2011, p=.02) which also differed from UC (4071±1884; p=.056). At 8 M, PFE differed from UC on mean Urine NA (3018±2087 vs. 4165±1848, p=.04); however PFE and FPI did not differ over time. Chi square analysis (6.4; p=.04) revealed that the proportion of subjects who met Urine NA criterion of ≤ 2500 mg per day at 8 M was higher in the FPI (41%) and PFE (50%) groups compared to UC group (20%). Diet NA analyses were concordant with Urine NA results.
Conclusion: Both FPI and PFE were effective in reducing dietary sodium intake compared to UC, however family partnership and support were superior in achieving a decrease in dietary sodium initially whereas the structured patient and family education showed slower sustained decrease over time. Greater efforts are warranted to incorporate and optimize family-focused education and support interventions into heart failure clinical care.