Key result
Avoidance of over-eating, maintaining a regular schedule, and exercising almost every day achieved clinically significant improvements in patient-reported outcomes for patients with chronic heart failure.
Why the study?
The minimal clinically important difference of a patient-reported outcome is deemed to have important clinical implications, but the clinical significance of chronic disease self-management for chronic heart failure based on this threshold needed evaluation.
Does chronic disease self-management (CDSM) improve patient-reported outcomes in patients with chronic heart failure?
Cohort (n=555)
Yes
Does chronic disease self-management (CDSM) improve patient-reported outcomes in patients with chronic heart failure?
Adherence to chronic disease self-management strategies, particularly avoiding over-eating and maintaining a regular schedule, yields clinically significant improvements in patient-reported outcomes for 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. 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.
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Tian et al. (2020) conducted a cohort in chronic heart failure (n=555). Chronic disease self-management (CDSM) behaviors vs. Minimal clinically important difference (MCID) threshold was evaluated on Overall summary score of the chronic heart failure patient-reported outcome measure (CHF-PROM). Avoidance of over-eating, maintaining a regular schedule, and exercising almost every day achieved clinically significant improvements in patient-reported outcomes for patients with chronic heart failure.
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