Design and usage of the HeartCycle education and coaching program for patients with heart failure

Stut, W., Deighan, C., Armitage, W., Clark, M., Cleland, J. G. and Jaarsma, T. (2014) Design and usage of the HeartCycle education and coaching program for patients with heart failure. JMIR Research Protocols, 3(4), e72. (doi:10.2196/resprot.3411) (PMID:25499976) (PMCID:PMC4275507)

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Abstract

Background: Heart failure (HF) is common, and it is associated with high rates of hospital readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF, but patient adherence to many self-care behaviors is poor. Objective: The objective of our study was to develop and test an intervention to increase self-care in patients with HF using a novel, online, automated education and coaching program. Methods: The online automated program was developed using a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviors and knowledge of the individual patient, and the system supports patients in adopting self-care behaviors. Patients are guided through a goal-setting process that they conduct at their own pace through the support of the system, and they record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The program was evaluated in the HeartCycle study, a multicenter, observational trial with randomized components in which researchers investigated the ability of a third-generation telehealth system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of HF (either new onset or recurrent) or were outpatients with persistent New York Heart Association (NYHA) functional class III/IV symptoms despite treatment with diuretic agents. The patients were enrolled from January 2012 through February 2013 at 3 hospital sites within the United Kingdom, Germany, and Spain. Results: Of 123 patients enrolled (mean age 66 years (SD 12), 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low-salt diet, 6 patients (5%) did not restrict their fluid intake, and 6 patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching program for physical activity and low-salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low-salt diet coaching. Conclusions: The HeartCycle education and coaching program helped most nonadherent patients with HF to adopt recommended self-care behaviors. Automated coaching worked well for most patients who started the coaching program, and many patients who achieved their goals continued to use the program. For many patients who did not engage in the automated coaching program, their choice was appropriate rather than a failure of the program.

Item Type:Articles
Additional Information:This research was supported by the European Commission under grant FP7-216695.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Stut, W., Deighan, C., Armitage, W., Clark, M., Cleland, J. G., and Jaarsma, T.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JMIR Research Protocols
Publisher:JMIR Publications
ISSN:1929-0748
ISSN (Online):1929-0748
Copyright Holders:Copyright © 2014 Wim Stut, Carolyn Deighan, Wendy Armitage, Michelle Clark, John G Cleland, Tiny Jaarsma
First Published:First published in JMIR Research Protocols 3(4): e72
Publisher Policy:Reproduced under a Creative Commons License

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