Dados do Trabalho

Título

Efficacy of the Educational Program for Self-Care in Heart Failure (PEAC-IC): randomized controlled trial

Introdução e/ou Fundamento

Self-care is one of the ways of controlling the symptoms and progression of heart failure (HF)1. Despite being known to be beneficial, self-care is still deficient among people with HF. To improve self-care, educational interventions should be implemented in clinical practice2. So, the Educational Program for Self-Care in Heart Failure-PEAC-IC is an intervention to promote positive outcomes for people with HF, and was evaluated in a pilot study for its acceptability and feasibility with satisfactory preliminary results.

Objetivo

To compare the effect of the PEAC-IC with usual care on self-care behaviors, knowledge, health-related quality of life and the number and duration of hospitalizations and emergency visits due to HF decompensation.

Materiais e Métodos

Single-center parallel randomized clinical trial, blinded for the outcomes and statistical analysis. Participants were randomly assigned to the intervention group(IG), which received the usual care and the PEAC-IC, offered in one face-to-face session and five telephone contacts with structured content and in the control group(CG), which received usual care only. Both groups were assessed at baseline(n=80) and for outcome assessments 1(n=56), 2(n=42) and 3(n=27). Efficacy analysis was based on intention-to-treat using the linear mixed models. The research was approved by the ethics committees and was registered on the Clinical Trials. 

Resultados

The PEAC-IC was effective in improving Self-Care Maintenance (p=0.012) and Management (p=0.018) and in reducing the length of hospital stay due to HF decompensation ​(p=<0.001) (Picture 1)However, there was no evidence of an effect concerning Self-care Confidence (p=0,691), number of hospitalizations (p=0,161) and emergency room visits due to HF (p=0,096), knowledge about HF, (p=0.660), quality of life (p=0.453) (Picture 2). Although it was not included as a dependent variable, death due to HF decompensation was identified in 7 people in the CG compared to only 2 in the IG. It should be noted that both the periods between the implementation of the PEAC-IC sessions (weekly) and the outcome assessments (7th week, 3 and 6 months after the 1st assessment) were longer than anticipated in the research protocol, due to the time it took for the participants to respond to the researchers' contacts. There was a greater loss to follow-up in the CG compared to the IG. 

Conclusões

PEAC-IC was effective in improving self-care maintenance and management, and reducing the length of stay hospitalization. We suggest evaluating the effectiveness of the PEAC-IC and implementing it in other contexts by including an assessment of HF mortality, reviewing the frequency of implementation of the PEAC-IC sessions in addition of the outcome assessment intervals and ways in which the CG adheres to the research protocol.