Wim Stut, Carolyn Deighan, John G Cleland, Tiny Jaarsma

The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient. The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days) admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA) Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system's database. Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101) improved during the study for daily weighing, low-salt diet, physical activity (P<0.001), and fluid restriction (P<0.05). Average adherence (n=120) to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%. Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was high and remained stable over time. However, adherence to daily reporting of symptoms was lower and declined in the long-term.