Sweden: Tablet device helps heart failure patients take the right dose of diuretics

One of the major consequences of heart failure is that blood is not pumped around the body as well as it should be, causing fatigue. Blood backs up waiting to enter the heart, leading to fluid accumulation in the legs, abdomen and the lungs.

Patients are prescribed diuretics which act on the kidneys to produce more urine, thereby reducing fluid retention. They are advised to monitor their weight, as a rapid loss could be a sign that the diuretic dose is too high, while a sudden weight gain could indicate fluid retention.

“Approximately 60 per cent of patients with heart failure receive treatment and follow up in primary care,” said Maria Liljeroos, a nurse and deputy head of the coronary care unit, Mälarsjukhuset Hospital, Eskilstuna, Sweden, and a PhD student at Linköping University, Sweden. “Providing education to increase self-care is often a challenge in primary care due to [limited] experience about heart failure and [a lack of] time.”

To improve the delivery of evidence-based care for heart failure patients in all parts of the healthcare system, in 2010 one county council in Sweden established heart failure clinics in primary care. It also decided to test whether an e-health tool, called OPTILOGG, could help patients self-manage their condition.

OPTILOGG is a pre-programmed tablet linked to a weighing scale that provides heart failure education, registers body weight and symptoms, and assesses the correct dose of diuretics. If the tool detects heart failure deterioration, the patient is instructed to increase the dose of diuretics. If weight gain is above a pre-determined range patients should contact the heart failure clinic.

Using OPTILOGG does not require patients to key in any information and it takes less than 30 seconds a day.

OPTILOGG was previously shown to improve self-care in patients followed up by specialised heart failure clinics after hospitalisation. The current study evaluated its effectiveness in primary care. The aim was to assess patient adherence to using OPTILOGG, to explore nurses’ experiences of the implementation, and to evaluate the effects on self-care behaviour.

The study included 32 patients from four primary care heart failure clinics. Participants were 65 years old on average and 31 per cent were female. The researchers found that 94 per cent of patients used OPTILOGG as intended. Nurses reported that the introduction of the tool did not increase their workload. The median total score on the self-care behaviour scale significantly decreased from 28.5 at baseline to 18 at four months.

Liljeroos said, “Patients’ self-care behaviours improved by 10.5 points or 37 per cent when they used OPTILOGG. The nurses said patients felt safer and were more committed to taking better care of themselves when using the tool. We also found that it did not create more work for nurses.”

The study shows that introducing OPTILOGG into primary care is feasible and has the potential to help patients with heart failure to manage their condition. Following the results, the tool is now available at all specialised and primary care heart failure clinics in the county.

Liljeroos presented ‘Implementation of an e-Health tool in heart failure clinics in primary care’ on 20 May at the EuroHeartCare meeting.