Symptom diary use and improved survival for patients with heart failure

Linda G. Park, Kathleen Dracup, Mary A. Whooley, Charles McCulloch, Chengshi Jin, Debra K. Moser, Robyn A. Clark, Michele M. Pelter, Martha Biddle, Jill Howie Esquivel

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


BACKGROUND: Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use. METHODS AND RESULTS: This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P=0.03). Depression and sex were not significant predictors of diary use in the adjusted model. CONCLUSIONS: In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes.

Original languageEnglish
Article numbere003874
JournalCirculation: Heart Failure
Issue number11
StatePublished - 2017

Bibliographical note

Funding Information:
REMOTE-HF study came from the National Heart, Lung, and Blood Institute and the National Institute of Nursing Research of the National Institutes of Health (NIH; 5R01HL83176-5). Dr Park is supported by the National Center for Advancing Translational Sciences of the NIH under award number KL2TR001870. We appreciate the support of the University of California, San Francisco Clinical and Translational Science Institute (grant No. UL1 TR000004). Dr Clark is supported by the Australian Heart Foundation Future Leader Fellowship (2015 FLF 100847).

Publisher Copyright:
© 2017 American Heart Association, Inc.


  • Attention
  • Body weight
  • Dyspnea
  • Heart failure
  • Mortality
  • Self-care
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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