Oral Papers: Medical Specialties I: Cardiology, Endorine, Renal
Background/Significance: Engagement in health behaviors, such as physical activity or a low sodium diet, is associated with improved medical outcomes in patients with heart failure (HF), but patients with HF frequently struggle to adhere to these behaviors. Positive psychological constructs (e.g., optimism, positive affect) may play a role in adherence, and positive psychology- (PP-) based interventions have been shown to increase these constructs in healthy and medically ill populations. However, there has been limited study of PP-based interventions in patients with HF.
Methods: We performed a three-arm, single-blinded, randomized trial to examine the feasibility and preliminary efficacy of a 12-week, telephone-delivered, PP-based health behavior intervention, compared to a motivational interviewing- (MI-) based intervention and treatment as usual, in 45 patients with New York Heart Association class I-III HF symptoms. Participants in the PP and MI groups completed weekly telephone calls with a study clinician for 12 weeks. Participants in the PP group completed a new PP exercise (e.g., writing a letter of gratitude, using a strength in a new way) and set goals related to physical activity, diet, or medication adherence each week. Those in the MI group received education about HF and HF-specific health behaviors and were encouraged to identify areas for improvement in health behavior adherence using MI tools (e.g., pros/cons, problem-solving). Feasibility (primary outcome) was measured by the number of PP sessions completed, while acceptability was measured using participant ratings of ease and utility of each PP exercise. The preliminary impact of the PP intervention was measured by changes in adherence, psychological health, and HF-related quality of life, from baseline to 12 and 24 weeks.
Results: Recruitment is complete, and follow-up data collection will be complete in August 2019. We hypothesize that the PP intervention will be feasible (the majority of participants will complete at least 7 of 12 sessions), acceptable (mean ease and utility ratings of at least 6 out of 10), and associated with non-significantly greater improvements in health behavior adherence, positive affect, and HF-related quality of life at the follow-up time points than the two control groups.
Discussion: The results of this intervention will provide us with critical information about the intervention’s feasibility, acceptability, and preliminary efficacy prior to a larger trial that will be powered to detect clinically meaningful differences between the PP-based intervention and an active control condition.
Conclusion/Implications: If effective, this intervention has the potential to have a significant impact on both mental and physical health in patients with HF, a high-risk population.