Role of compliance to dietary and physical activity recommendations for better quality of life in patients with chronic heart failure
Authors: Georgieva M , Rushid N , Nankova M , Borisova S , Yotov Y 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Varna, fund Science

Background
Diet and physical activity are important non-pharmacological determinants for the prognosis in patients with chronic heart failure (HF). The role of nurse in patient education and follow-up of these factors is of paramount importance for improvement the quality of life.

Aim
to determine the effect of adherence to life style recommendations for the better quality of life of patients in ambulatory HF program.
Participants and methods: Overall, 72 patients with HF were included in a structured ambulatory program after hospital discharge, with the active participation of a nurse in it. After a 6-month follow-up, 61 finished the program. All patients were educated at the beginning and at the follow-up visits for their appropriate diet and physical activity by the health care practitioner. The adherence to the above mentioned life style measures was evaluated by asking the participants whether the follow the given recommendations. Quality of life was assessed by the change in NYHA class, 6-minute walking test (6MWT) distance, questionnaires (KCCQ, EQ-5) and self-assessment by visual analogue scale. For continuous variables, t-test and Mann-Whitney test was used depending on the normality of the distribution. For categorical variables, chi-square or Fisher’s exact test were applied where appropriate. Logistic regression was used to test the effect of adherence to advices for life- style parameters.

Results
There was no difference in age and sex distribution between the compliant (C) and non-compliant (NC) group (Table 1). All patients were medically treated according to the current guidelines. There was significant improvement in the functional capacity in adherent to treatment patients. The increase in 6MWT (Table 1) was on average 39.16 m more in the compliant group (p = 0.016). You have 6 times higher chance to improve your 6MWT performance if you are compliant – OR 6 (95%CI 1.02-31.11, p = 0.047). There was also slightly better improvement in NYHA class – mean change 0.9 vs 0.7, p = NS. The quality of life was also improved more significantly in the C than in NC group (Table 1). Clinically meaningful improvement in overall summary score (OSS) &gt;5 points was observed in 92% in C vs 64% in NC (p = 0.0.029) and moderate to large improvement &gt;10 points – in 82% vs 54.5% (p = 0.05). There was also a trend to better anxiety and depression attitudes at the end of the 6 months in the C than in NC patients.

Conclusions
The adherence to diet and physical activity advices improves the physical capacity and the quality of life in patients with HF even just after 6 months. In this respect, the role of the health care practitioner is of invaluable importance to promote the life style changes. This includes education and proper ambulatory follow-up by a trained nurse.Table 1