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Patient and Caregiver Shared HF Knowledge Affects Outcomes
Study Questions:
The goals of the study were to 1) identify configurations of shared heart failure (HF) knowledge in patient-caregiver dyads; 2) characterize dyads within each configuration by comparing socio-demographic factors, HF characteristics, and psychosocial factors; and 3) quantify the relationship between dyadic configuration of HF knowledge and patient self-care adherence to managing dietary sodium and HF medications.
Methods:
This study was a secondary analysis of baseline data (n =114) from a previous prospective clinical trial of a patient-caregiver intervention trial. Patients had to have an unpaid caregiver helping with HF self-care and were not required to be a family member. After randomization into three groups, data were collected on HF knowledge, autonomy of support, depressive symptoms, patient quality of life, caregiver quality of life, sodium intake, and medication adherence.
Results:
There was variability in knowledge among the groups, with the patient having a higher level than the caregiver (4.9% ± 1.3; p < 0.001). Patient-caregiver dyads with the highest level of knowledge of self-care had better adherence to low-sodium diet and medication. Patient-caregiver dyads with the lowest level of knowledge of self-care had lower adherence to low-sodium diet; medication adherence was not affected. The group with the highest knowledge was predominately white and had a higher educational level. In that group, the patient had a higher left ventricular ejection fraction, fewer depressive symptoms, and better autonomy support, and the caregiver had better quality of life.
Conclusions:
The level of knowledge that patients and caregivers have about the pathology of HF, the definition of a low-sodium diet, and the role of medications can affect patient outcomes. The complexity of the patient-caregiver dyad has not been previously studied, but this study recognizes that the interaction can have an impact. Educational sessions need to address the education of the caregiver and recognize its impact on patient outcomes.
Perspective:
Social support has been recognized as an important factor in outcomes of patients with HF. Including caregivers in educational self-care programs has been shown to improve adherence to low-sodium diet. The caregiver’s educational level and perceived quality of life can have an impact on the patient’s ability to adhere to low-sodium diet and medications. Assessing the level of knowledge and understanding of HF is important in the care of vulnerable populations.
Keywords: Heart Failure, Caregivers, Self Care, Social Support, Medication Adherence, Diet, Sodium-Restricted, Sodium, Dietary, Quality of Life, Depression, Vulnerable Populations
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