A trial of family partnership and education interventions in heart failure

Abstract

Background: Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA).

Methods and results: HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ(2)(2) = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention.

Conclusions: Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.

Keywords: Self management; adherence; autonomy support; dietary sodium; medication adherence.

Figure 1

Consort Chart

Figure 2

24-hour Urine Sodium Over Time. Markers indicate means adjusted for covariates (gender, BDI, Furosemide Equivalents) for each group. Error bars indicate 95% confidence intervals. At 8mo there was a significant group difference (p=.022): post hoc tests indicated FPI group was significantly lower than UC at 8 M (p=.018). Covariates: Gender (p=.001), BDI-II (p<.001), Furosemide Equivalents (p=.012).

Figure 3

Dietary (3DFR) Sodium Over Time. Markers indicate means adjusted for covariates (gender and BDI) for each group. Error bars indicate 95% confidence intervals. At 4mo there was a significant group difference (p=.011): post hoc tests indicated PFE was significantly lower than UC (p=.042) and FPI group was significantly lower than UC (p=.018). No significant time effect was found for UC. However there were significant time effects for PFE (p=.005) [post hoc tests indicated significant reduction between BL-4mo (p=.015) and no significant change from 4–8Mo (p=1.000)] and for FPI (p=.008) [post hoc tests indicated significant reduction between 0–4mo (p=.006) and no significant change from 4–8M (p=.684)]. Covariates: Gender (p=.001), BDI (p=.152).

Figure 4

Proportion in Each Group Adherent to Low Sodium Diet (≤ 2,500 mg/day) Across Time. UC is less likely to be in the adherent (≤2500mg/day) category than intervention groups at 8 M, Chi Square= 7.076, p=0.029.