Effects of Family Sodium Watchers Program on Outcomes in Heart Failure Patient-Family Caregiver Dyads

Effects of Family Sodium Watchers Program on Outcomes in Heart Failure Patient-Family Caregiver Dyads Heart failure (HF) emerged as a significant public health threat in the 1990s and has now reached epidemic proportions. Despite advances in the medical treatment of HF, patients with HF face frequent hospitalizations for acute exacerbations. Inadequate self-management strategies, in particular non-adherence to a sodium restricted diet, is a main cause of these rehospitalizations. Prior interventions to increase adherence have focused on increasing knowledge about restricting sodium in the diet with limited success. Unaddressed by these interventions are the major barriers of difficulty measuring and tracking daily sodium intake, family members who continue to eat high sodium diets, and a preference for salty foods - particularly in the elderly who have a decreased sense of taste. It is possible to retrain the taste buds to enjoy low salt foods by gradually reducing the amount of sodium in foods over the course of 16 weeks. This retraining works best with direct involvement and support from family members. The Family Sodium Watcher Program (Family SWaP) proposed in this study incorporates the use of a unique electronic salt monitoring device that easily measures salt content in food which is the major source of sodium. The intervention is designed to improve adherence to a sodium restricted diet by both patients and family caregivers through education and strategies for gradual taste adaptation to low salt foods. The purpose of this 2-group randomized, controlled, repeated measures (baseline, 4-month, and 12-month) study is to examine effects of Family SWaP on adherence (24-hour urine sodium excretion) to a sodium restricted diet (SRD), knowledge, attitudes, and barriers about SRD, perceived control, and perceived social support (in patient-caregiver dyads); caregiving burden (in caregivers only); and symptom distress and rehospitalizations (in patients only). We will enroll a total of 220 patient-caregiver dyads. Dyads will be stratified as adherent and nonadherent using baseline patients’ 24-hour urine sodium excretion (a cut point =3000mg) and then randomly assigned to one of 2 groups: 1) Family SWaP intervention (two 90-minute home visits followed by 4 weekly 30-minute phone calls) group, or 2) a usual care control group. Patient-caregiver dyads will complete questionnaires (knowledge, attitudes, and barriers about diet; symptoms distress; perceived control; perceived social support; caregiving burden; and quality of life) and collect a 24-hour urine for sodium excretion at each assessment. Data will be analyzed using repeated measures ANOVA, Cox regression, and an innovative actor-partner interdependence model dyadic analysis for longitudinal data. This dyadic intervention study will provide rich data on the complex, interpersonal relationships within patient-caregiver dyads that affect adherence and health outcomes in patients with HF and family caregivers. Given the recommendation that all individuals should consume a SRD, the intervention has the potential for expanded application beyond patients who need to follow a SRD for cardiovascular reasons to everyone consuming a diet high in sodium. Keywords: heart failure, adherence, sodium restricted diet, intervention, caregiver.