Goal Setting and Life Style Changes for Self-Management in Heart Failure Patients with Metabolic Syndrome

The prevalence of heart failure and metabolic syndrome has significantly increased in the US, creating a unique situation for patients battling both conditions. Behavioral factors such as noncompliance with medications, diet and delay in seeking preventive care may contribute to hospital readmissions and premature mortality. Thus patients with heart failure and metabolic syndrome could benefit from education that stresses effective self-management in the context of aggressive multidisciplinary care. The purpose of this study was to examine the impact of patient education using realistic, incremental goal setting to achieve increased self-confidence and subsequent improvements in patient lifestyle and management techniques. Health education for secondary and tertiary prevention by trained health educators (instead of Nurses) was conducted as part of a multidisciplinary team. Respondents comprised 72 patients at Ben Taub General Hospital randomized to either usual care (usual doctor; n=36) or collaborative care (multidisciplinary team: heart failure-cardiologist, metabolic syndrome-endocrinologist, case manager, and health educator; n=36). Mean age of respondents in collaborative care was 53.5 (SD=9.3). The majority were high school educated (mean = 11.5 years), females (55%), no health insurance (45%), and minorities (34% Hispanic & 51% African Americans).The multidisciplinary team agreed on nine important goals: medication compliance, increased exercise, sodium reduction, diabetic diet, weight loss, smoking cessation, eye exams, dental exams and weight monitoring. Collaborative care (n=36): 41.6% patients set goals, 8.3% achieved those goals, 22.2% set a second goal and 8.3% achieved that second goal. The most common goals chosen by patients included sodium reduction, diabetic diet and medication compliance.