Semester

Spring

Date of Graduation

2024

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Not Listed

Committee Chair

Mary Jane Smith

Committee Member

Roger Carpenter

Committee Member

Lisa Henry

Committee Member

Jennifer Mallow

Committee Member

Kesheng Wang

Abstract

ABSTRACT

Self-Care and Quality of Life of Remotely Monitored Appalachians with Heart Failure

Patrick R. Murphy

Background: About 6.2 million persons are living with heart failure in the United States and over 960,000 new cases are diagnosed annually. The cost to provide care to this population exceeds $30 billion per year. Rates of heart failure are higher in the Appalachian region where persons are more likely to experience poverty, lack resources, and be geographically isolated. Heart failure coupled with these unique challenges can negatively impact self-care and quality of life. Numerous interventions have been attempted to support this population, but results have been mixed and usually minimal at best. Remote monitoring through an implanted device may provide a solution to enhance self-care and quality of life for these persons.

Purpose: The purpose of this study was to contribute to the body of knowledge of nursing by exploring the impact of remote monitoring on self-care and quality of life for persons with heart failure in Appalachia.

Method: The study used a quasi-experimental, post-test only design with nonequivalent groups. Following IRB approval, adults living in Appalachia with NYHA Class III heart failure being seen in a cardiology heart failure clinic were recruited into a remotely monitored intervention group (already implanted with CardioMEMS remote monitoring device) or into the non-monitored, control group. Fifteen persons were recruited into each group for a total sample size of 30. After completion of informed consent, a telephone interview was scheduled during which the Self-Care in Heart Failure Index version 7.2 and Minnesota Living with Heart Failure Questionnaire were completed along with some demographic questions. Data was analyzed using descriptive statistics, independent samples t-tests to determine differences between groups for self-care and quality of life dependent variables, and generalized linear models to determine any influence of independent variables on the dependent outcome variables (self-care and quality of life variables). A GLM was also run to determine if self-care variables had influence on the quality of life variable.

Results: The sample was predominantly male (66.7%) with an average age of 67.2 years (range 31-87). The entire sample identified as white (100%) and 50% were retired. Rates of key comorbidities (hypertension, CAD, diabetes, sleep apnea, obesity) were higher in the intervention group. No statistically significant differences were found between the remotely monitored and non-monitored persons with heart failure for the self-care and quality of life variables. Per the GLM’s, some predictor variables (home internet access, months since HF diagnosis, self-care confidence, and remote monitoring) were shown to have influence on self-care monitoring and/or self-care management variables at a statistically significant level (P <.05). No self-care variables were shown to have influence on quality of life per the GLM.

Conclusion: Due to the limited sample size of remotely monitored persons and challenges identifying NYHA Class III heart failure in the control group, the sample size was too small. The study’s hypotheses related to self-care and quality of life could not be supported given the study data. Findings may support capture of home internet access and self-care confidence scores when caring for this population as these had influence on self-care monitoring and self-care management. Future studies should have larger sample sizes and random assignment to groups to control for extraneous variables in this challenging population.

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