Key result
Chronic disease self-management strategies, specifically avoidance of over-eating, maintaining a regular schedule, and daily exercise, significantly improved patient-reported outcomes in heart failure patients, reaching minimal clinically important differences.
Why the study?
The clinical significance of chronic disease self-management for patients with chronic heart failure based on the minimal clinically important difference of patient-reported outcomes had not been evaluated.
Does chronic disease self-management advice improve patient-reported outcomes in patients with chronic heart failure?
Cohort (n=555)
Yes
Does chronic disease self-management advice improve patient-reported outcomes in patients with chronic heart failure?
Effect estimate: OS increased by 4.13 per grade for avoidance of over-eating, 3.66 for regular schedule, 2.84 for exercise, and 1.71 for low-sodium diet
p-value: p=<0.05
Adherence to chronic disease self-management strategies, particularly avoiding over-eating, maintaining a regular schedule, and exercising, significantly improves patient-reported outcomes in patients with chronic heart failure.
PURPOSE: The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure-PRO measure (CHF-PROM). METHODS: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from July 2018. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with β values of CDSM obtained from the multi-level models to further evaluate the clinical significance. The STROBE checklist is shown in Additional file 1. RESULTS: Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating (12.39 vs. 9.75) and maintenance of a regular schedule often (10.98 vs. 9.75), and exercise almost every day (11.36 vs. 9.75) reached clinical significance for the overall summary. Avoidance of over-eating (5.88 vs. 4.79) and a regular schedule almost every day (4.96 vs. 4.79) reached clinical significance for the physical scores. Avoidance of over-eating half of the time (5.26 vs. 4.87) and a regular schedule almost every day (5.84 vs. 4.87) demonstrated clinical significance for the psychological scores. CONCLUSIONS: This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure. TRIAL REGISTRATION: Current Prospective Trials NCT02878811; registered August 25, 2016; https://clinicaltrials.gov/ct2/show/NCT02878811?term=NCT02878811&draw=2&rank=1 .
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Tian et al. (2021) conducted a cohort in Chronic heart failure (n=555). Chronic disease self-management (CDSM) strategies vs. Lower frequency of self-management behaviors was evaluated on Overall summary score of the chronic heart failure-patient reported outcome measure (CHF-PROM) (OS increased by 4.13 per grade for avoidance of over-eating, 3.66 for regular schedule, 2.84 for exercise, and 1.71 for low-sodium diet, p=<0.05). Chronic disease self-management strategies, specifically avoidance of over-eating, maintaining a regular schedule, and daily exercise, significantly improved patient-reported outcomes in heart failure patients, reaching minimal clinically important differences.
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