Caregiver Contributions in Heart Failure Require Further Study

A secondary analysis of data from patients living with heart failure and their caregivers, conducted as part of the MOTIVATE-HF (MOTIVATional interviewing to Improve Self-care in Heart Failure Patients) trial, shows that although caregivers were able to improve their how well they provided care following motivational interviewing—via betterment of self-efficacy—the amount of care they provided did not improve concurrently.

“Caregiver self-efficacy, which is caregiver confidence in the ability to help the patient in performing self-care, directly influences caregiver contribution to self-care, while acting as a mediator between predictors of caregiver contribution to self-care and caregiver contribution to self-care itself,” the study authors noted. “Although caregiver self-efficacy is associated with patient and caregiver outcomes, evidence on interventions aiming to improve this variable, as well as CC to self-care, is scarce.”

These findings were presented by Giulia Locatelli, PhD candidate at the University of Rom Tor Vergata and the Australian Catholic University, during a rapid-fire oral abstract session at this year’s ACNAP-EuroHeartCare conference held May 21-24 in Madrid, Spain, and online.

All of the caregivers (n = 235) and patients (n = 238) who participated in this subanalysis were divided into 3 study groups; they were recruited from 3 medical centers in Italy. Arm 1 comprised motivational interviewing for patients, arm 2 was motivational interviewing for patients and caregivers, and arm 3 was usual care. The primary outcomes were improvement in caregiver self-efficacy while caring for patients living with heart failure and caregiver contributions to self-care for these patients following motivational interviewing.

Following assessment of the caregivers via the Caregiver Contribution to Self-Care of HF Index, these results were seen:

• At 9 months after the intervention, caregiver self-efficacy scores in arm 2 were 8.36 points higher compared with arm 3 (95% CI, 3.13-13.59; P = .002).
• By 12 months after the intervention, arm 2 scores remained higher vs arm 3, although there was a slight dip to 6.59 (95% CI, –0.41 to 13.60; P = .064).

A longitudinal mixed linear model that considered time, living with a patient, randomization arm, and interaction confirmed that caregiver self-efficacy significantly improved (β ̂ = 1.39; 95% CI, 0.02-2.75; P = .046) and that their contributions to patient self-care also improved over time. However, the latter was determined to not be statistically significant.

Those receiving the motivational interviewing intervention had 1 in-person session and 3 telephone sessions, and their data were collected at 6 time points: baseline, before the intervention, and at 3, 6, 9, and 12 months post enrollment. Sixty percent of the caregivers lived with their patients, and 61.9% of the patients had a New York Heart Association class II heart failure diagnosis.

“Further studies need to better understand how caregiver self-efficacy affects the caregiver contribution to self-care, how caregiver self-efficacy can be further improved, and the necessary intensity of motivational interviewing to improve caregiver contributions to self-care,” the authors concluded. “Our results show that motivational interviewing was effective in improving caregiver self-efficacy, but not the caregiver contribution to self-care. This may indicate that MI was able to improve how well caregivers were supporting patients, as showed by improvements in self-efficacy, but not how much they were doing it.”

Reference

Locatelli G, Zeffiro V, Occhino G, et al. Motivational interviewing improves caregiver self-efficacy in heart failure: a secondary outcome analysis of the MOTIVATE-HF trial. Presented at: ACNAP-EuroHeartCare 2022; May 21-24, 2022; Madrid, Spain, and online.