The study is funded by a $5 million grant from the National Heart, Lung and Blood Institute, which is part of the National Institutes of Health.
Currently, up to 90 percent of patients with heart failure do not follow their physicians' recommendations, which can have detrimental effects on the progression of their condition, according to Lynda Powell, PhD, associate chairperson, department of Preventive Medicine at Rush and principal investigator on this study. Heart failure is one of the few cardiovascular diseases that is increasing. There are approximately 465,000 new cases each year and during the next 40 years, this number is expected to double, according to the American Heart Association.
Heart failure is a condition in which the heart is unable to maintain the normal circulation of the blood. The heart gets progressively weaker, making it difficult to pump blood through the entire body. "Patients with chronic illnesses like heart failure must become partners with their doctors," Powell said. Doctors can treat patients and prescribe courses of action but patients need to uphold their end of the bargain if they are to live happy and healthy lives. "This study seeks to test which of two different forms of behavior management will best help patients manage their illness."
Patients recruited for the trial will take either an 18-week course on behavior management skills or receive weekly tip sheets on these topics and phone contact with a nurse. Both groups will receive standard medical management for chronic heart failure their own physicians.
The 18-week course will be led by trained psychologists and will cover behavioral self- management topics such as relaxation, alteration of anger and depression, reengineering their homes to support lifestyle changes and systematically monitoring their own progress, Powell said. The tip sheets will cover similar material but will not require attendance at group sessions.
Powell said the course and the handouts teach patients how to monitor their reactions to stressful events by learning to resist the body's natural tendency to gear up for conflict and, instead, take a more calm, reasoned approach to a stressful event. "Cognitive restructuring" helps those patients to realize that how they think influences how they feel.
"This 'cognitive restructuring' tries to get people to think about stressful events as opportunities to take action instead of opportunities to blame," Powell said. Environmental rearranging involves restructuring the home environment to comply with exercise and diet recommendations.
"For instance, if you need to exercise more and decide to walk in the mornings, it's best to have your outdoor gear near your bed so you can wake up, put your clothing on and go," Powell said. "When people try to make changes in their lifestyle, they frequently have relapses. These relapses are a natural part of change. Once they occur, we teach patients to get 'back on the horse,'" Powell said.
There are seven Chicago-area hospitals participating in the study. Lutheran General, Evanston Hospital and Rush North Shore comprise the Northern group, while Rush-Presbyterian-St. Luke's Medical Center, Cook County Hospital and the University of Illinois Medical Center comprise the Western group. Advocate Christ Hospital is the only hospital in the South region.
For more information or to enroll patients should call 312/563-2609 or 312/563-2287, Monday through Friday from 9 am to 5 pm.
Rush-Presbyterian-St. Luke's Medical Center includes the 824-bed Presbyterian-St. Luke's Hospital; 110-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two million people through its outpatient facilities and five member hospitals.