Self-management skills provide limited benefits in heart failure patients

　　奥兰多，11月4日――AHA2007一项最新临床试验结果宣布：与强化患者教育相比，心衰患者自我管理技能培训教育，并没有更多收益。

　　在HART试验中，研究者入选轻、中度心衰患者分别进行强化教育和自我管理技能培训，来观察哪种方式能更有效地减少死亡率和住院率。

　　该研究带头人，伊利诺斯州芝加哥Rush大学医疗中心预防医学、内科学（心血管）、行为学、药理学教授Lynda H. Powell说：“我们希望轻中度心衰患者经过自我管理技能训练，比接受强化健康教育组更能减少全因死亡率和心衰住院率。”

　　研究包括902名收缩或舒张性心力衰竭患者，平均随访34个月。历经1年多以18个小组讨论会的方式进行自我管理技能培训干预。

　　干预的目的是，通过向患者发放活页资料促进AHA宣教的实施，并让患者掌握5种为治疗心衰而调整的生活方式。在网站www.americanheart.org/heartfailure可获得该活页内容，包括节食、烹饪、与医生交流、锻炼、心衰的症状和治疗、为治疗心衰而改变的生活方式。

　　治疗一年后，虽然未能改善药物依从性，但是两组患者的自我效能感和抑郁情绪均得到了改善。在2-3年随访结束时发现，至死亡或因心衰住院的时间两组无差异。两组的死亡率和住院率也无差异，结果相似。亚组分析结果显示至少接受9个自我管理技能培训的患者，以及基线水平功能贮量差、药物依从性差及收入少于5,0000美元的患者，其死亡率和心衰住院率有改善。

　　Powell说：“我们发现：与仅进行宣传教育相比，对轻中度心衰进行自我管理培训教育并不能改善死亡率或住院率。”

　　她说，对一些有特殊需求的人群，如功能贮量差、药物依从性差和低收入者来说，自我管理培训可有效地减少死亡率和再住院率，“需要对目标患者进行有说服力的自我行为管理试验，以评估其在重要临床终点的获益情况。”

　　这项研究由国家心肺及血液研究中心 (NHLBI)支持

　　（AHA上报告的研究作者已声明：纯属个人研究该结论，不代表协会立场。AHA不代表或保证其结论的准确性与可靠性。）

Self-management skills provide limited benefits in heart failure patients

ORLANDO, Nov. 4 –Training heart failure patients in self-management skills doesn’t have additional benefits over enhanced patient education, according to late-breaking clinical outcomes results announced at the American Heart Association’s Scientific Sessions 2007.

In the Heart Failure Adherence and Retention Trial (HART), researchers enrolled people with mild to moderate heart failure in one of two types of patient education programs to see which approach would be most effective in reducing death and hospitalizations.

“We anticipated that in patients with mild to moderate heart failure, a self-management skills training intervention, compared to enhanced health education, would reduce all-cause mortality or hospitalization for heart failure,” said Lynda H. Powell, Ph.D., lead investigator of the study and professor of preventive medicine, medicine (cardiology), behavioral sciences, and pharmacology at Rush University Medical Center in Chicago, Ill.

The study included 902 patients with systolic or diastolic heart failure.The average follow-up was 34 months.  The self-management skills training intervention took place in 18 small group counseling sessions over one year.

Goals of the intervention were to provide heart failure education using American Heart Association tip sheets to implement recommendations from the tip sheets, and to master using five self-management skills chosen because of their relevance to lifestyle changes required to manage heart failure. The sheets, available at www.americanheart.org/heartfailure, include tips on diet, cooking, talking with a doctor, exercise, symptoms and treatments of heart failure, and lifestyle changes for managing heart failure.

After one year of treatment, there was no benefit on drug adherence, however both groups improved on self-efficacy and depression.By the end of the two-to-three year follow-up, time to death or hospitalization for heart failure did not differ between the two treatment arms. Results were similar for the outcome of death or all-cause hospitalization. Subgroup analyses showed a benefit on death or heart failure hospitalization for those who received at least half of the 18 self-management sessions and had, at baseline, poor functional capacity, low drug adherence or income <$50,000.

"We found that the policy of offering self-management skills training and education did not provide benefit over providing the tip sheets for education alone on mortality or heart failure hospitalization in patients with mild to moderate heart failure," Powell said.

She said self-management training may effectively reduce death or heart failure rehospitalization in those with particular needs such as poor functional capacity, low adherence to drugs and low income. “Robust behavioral self-management trials evaluating sustained benefit on important clinical endpoints in targeted patients are needed” Powell said.

Support for this study was provided by National Heart, Lung, and Blood Institute.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.The American Heart Association makes no representation or warranty as to their accuracy or reliability.