Heart Failure (HF) self-care improves patient outcomes but trials designed to improve HF self-care have shown inconsistent results. Interventions may be more effective in improving self-care if they mobilize support from providers, promote self-efficacy, increase understanding of HF, increase the family involvement, and are individualized. All of these elements are emphasized in motivational interviewing (MI); few trials have been conducted using MI in HF patients and rarely have caregivers been involved in MI interventions. The aim of this study will be to evaluate if MI improves self-care maintenance in HF patients, and to determine if MI improves the following secondary outcomes: a) in HF patients: self-care management, self-care confidence, symptom perception, quality of life, anxiety/depression, cognition, sleep quality, mutuality with caregiver, hospitalizations, use of emergency services, and mortality; b) in caregivers: caregiver contribution to self-care, quality of life, anxiety/depression, sleep, mutuality with patient, preparedness, and social support.
A three-arm randomized controlled trial will be conducted in a sample of 240 HF patients and caregivers. Patients and caregivers will be randomized to the following arms: 1) MI intervention to patients only; 2) MI intervention to patients and caregivers; 3) standard of care to patients and caregivers. The primary outcome will be measured in patients 3 months after enrollment. Primary and secondary outcomes also will be evaluated 6, 9 and 12 months after enrollment.
This study will contribute to understand if MI provided to patients and caregivers can improve self-care. Because HF is rising in prevalence, findings can be useful to reduce the burden of the disease.
Launched in 1987, the Study of Osteoporotic Fractures became the longest-running study in the 54-year history of the Kaiser Permanente Center for Health Research.
For more than 30 years, amid an ever-changing landscape of research topics and funding cycles, the Study of Osteoporotic Fractures (SOF) was an enduring project at the Kaiser Permanente Center for Health Research (CHR) in Portland, Oregon. This nationwide trial of women and healthy aging, involving more than 100 researchers and staff, is the longest-running study to date in CHR’s 54-year history.
While SOF has ended, findings from the study continue to be published — including the final manuscript by CHR researchers. That paper, published in the Journal of the American Geriatrics Society, demonstrated that for women who live past the age of 80, moderate weight loss over a 20-year period is associated with higher risk of hip fracture, poor physical function, and mortality.
“As Americans, we are living longer, and with age comes the inevitable complications both clinicians and patients should know about,” explained Dr. LeBlanc. “Identifying risk factors that might contribute to a decline in quality of life and overall health as women age has been one of the hallmarks of the SOF study throughout this three-decades-long project.”
In this latest study, Dr. LeBlanc and others on the research team found that for every 22 pounds lost over 20 years, women had a 23 percent greater risk of death and a 52 percent greater risk of hip fracture. Women who lost a small amount of weight also had a greater risk of death — but not of hip fracture — than those with no weight loss.
“Our results suggest long-term weight loss in older women may be a marker for increased risk of poor health outcomes,” the authors wrote. “Therefore, we should pay attention to women who have survived into their 80s and 90s who have experienced moderate weight loss, regardless of whether there was an abrupt weight decline.”
A summary of the findings was published on the blog healthinaging.org, which is produced by the American Geriatrics Society’s Health in Aging Foundation.
Over SOF’s 31 years, more than 10,000 women — one-fourth of them Kaiser Permanente Northwest members — participated in the project, which was funded by the National Institutes of Health. SOF researchers initially focused on what put women at risk for fractures, but later expanded their inquiry to many other areas related to aging, including breast cancer, heart disease, and vision problems. To date, the researchers have published more than 400 scientific papers.
Dr. LeBlanc began working on SOF in 2009, initially under the mentorship of CHR Distinguished Investigator Teresa Hillier, MD.
“This monumental study has resulted in hundreds of findings that go beyond the project’s original mandate and have, without a doubt, led to a better understanding of the aging process for women,” explained Dr. Hillier.
“While we owe a great debt to the dozens of researchers who have worked on this project over thirty years, we wouldn’t have been able to do it at all without the participation of each of the 10,000 women who volunteered to be a part of this landmark project.”
Dr. LeBlanc agrees: “It has been one of the great privileges of my career to hold a role in SOF and to know my work has contributed to a better understanding of healthy aging for women,” she said.