Patient-Centered Intervention: Symptom Management in Older Heart Failure Patients
Sandra K. Plach, PhD, RN, Project Director
Susan M. Heidrich, PhD, RN, FAAN, Co-Investigator
PROJECT ABSTRACTRelevanceSymptom interpretation and symptom self-management are important components of HF care. By addressing the correct interpretation of symptoms, which will improve self-management strategies in response to symptoms, the HEART-IRIS intervention has potential to reduce symptom distress, improve quality of life and prevent HF exacerbations and hospitalizations in older adults with HF.
Project Summary Heart failure (HF) is an escalating public health problem that disproportionately affects older adults and is the leading cause of hospitalization among persons over the age of 65. Early recognition and monitoring of HF symptoms and timely initiation of self-management when symptoms worsen can prevent hospitalizations, minimize complications, and maintain life quality. Individuals can contribute to HF symptom control by engaging in self-management strategies that include monitoring the frequency and intensity of symptoms and seeking help when symptoms worsen. However, this may only be successful when people’s representations regarding their symptoms are accurate and linked to appropriate behavioral strategies. The purpose of this study is to test the feasibility of HEART-IRIS, an innovative, individualized, representational intervention to improve symptom self-management in older HF patients. A two-group, repeated measures experimental design will be used. A sample of 60 men and women aged 65 and older with a diagnosis of HF will be randomly assigned to HEART-IRIS or Wait-List Control. The HEART-IRIS intervention consists of a counseling interview with an advanced practice nurse conducted by telephone. During the interview symptom number and severity are assessed, one or more symptoms are targeted for intervention, representations are elicited and goals and strategies for symptom self-management are formulated. Telephone reinforcement sessions of the intervention are carried out bi-weekly for 8 weeks. The symptom management plan is revised as needed. Symptom distress will be assessed at baseline, at 2, 4, 6, 8 weeks, and at follow-up (16 weeks). Wait-list control subjects will be offered the intervention after the 16-week follow-up assessment. Symptom self-management behaviors will be assessed at 2, 4, 6, 8, and 16 weeks. Subject satisfaction, quality of life, health care utilization, and intervention costs will be assessed. Beliefs and barriers to self-care of symptoms in older adults with HF will be identified.