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Self-management in heart failure questioned

By Lilian Anekwe

Training heart failure patients in how to self-manage their condition may not be any more effective than simply giving them education.

Self-management often forms an important part of care plans for chronic disease, but new research questions whether the strategy is as effective as has been assumed.

In the Heart Failure Adherence and Retention Trial (HART), which was presented at the at the American Heart Association annual meeting this week, researchers enrolled 902 patients with systolic or diastolic heart failure.

Patients in the intervention group were taught self-management skills at 18 group sessions over one year, in addition to the patient materials provided to the comparison group.

But after an average follow-up period of 34 months, patients who had been taught how to self-manage their heart failure had were no more likely to comply with their mediction. There were also no significant difference in time to death, hospitalisations for heart failure or all-cause hospitalisations.

Both the intervention and the comparison group showed improvements in managing the depression caused by living with a chronic condition.

Professor James Calvin, professor-in-chief at the Rush University medical center in Chicago, told delegates at the conference that self-management may still a valid option in selected groups of patients.

‘We saw that patients with the lowest and poorest physical functionality, low drug adherence and low in-come, had about half the risk of death of hospitalisation, with an odds ratio of 0.47.

‘This suggests that in the patients who really need it, self-management may still be useful.

‘What we found will enable us to really drill down and find those groups of patients in which self-management will be useful and will get the best results.'

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