Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

NRI 95-244 – HSR Study

NRI 95-244
Effect of Behavioral Management on Quality of Life in Heart Failure
Martha J. Shively, PhD RN
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: April 1998 - March 2002
Nurses play an important role in helping patients to manage symptoms, adhere to treatment, and change behavior. There has been a lack of research regarding nonpharmacologic interventions with patients with heart failure and other chronic conditions.

The primary objective of this 4-year study was to determine the effect of a nurse-led behavioral management intervention on health-related quality in patients with medically-managed heart failure. The secondary objective was to assess the impact of the behavioral management intervention on health care resource utilization.

DESIGN: randomized controlled trial. SETTING: single site, VA San Diego Healthcare System. SAMPLE: Patients were enrolled in 11 cohorts a total of 116 outpatients were randomly assigned to one of two treatment groups to evaluate the clinical impact of the intervention. Group 1 received usual care for patients with heart failure (n=58). Group 2 was an augmented group receiving usual care plus participation in the 15-week (4-month) behavioral management program (n=58). Inclusion criteria were that the patient had a primary diagnosis of heart failure, a VA primary care provider, stable symptoms for at least one month and was able to walk. INTERVENTION: The behavioral management program augmented usual care and consisted of establishing specific goals with patients related to healthier diet, increased quality and amount of exercise, smoking cessation, and increased social and interpersonal activities. DEPENDENT VARIABLES/OUTCOME MEASURES: The five major dependent variables for this study were psychological symptom distress (Multiple Affect Adjective Check List - MAACL), physical functioning (SF-36 physical component summary score), mental functioning (SF-36 mental component summary score), exercise capability (6-Minute Walk), and general health perceptions (SF-36 general health scale score). Dependent variables were assessed at baseline, at the end of treatment (at 4 months), and then at 10 and 16 months. DATA ANALYSIS: Initial analyses included all subjects who were randomized to treatment and completed all data collection time points in a series of 2 by 4 ANOVAs with time as a repeated measure.

Participants were mostly male (95%) and Caucasian (75%), with a mean age of 67 (SD 10) and in functional/SAS classes II and III. There were no group differences on the MAACL or SF-36 scores. Younger patients (< 60 years) in the intervention group had a significantly greater 6-Minute Walk distance over time than those in the control group (p =. 02). Intervention patients showed significantly improved MLHF physical dimension scores over time compared to control patients (p =.03). The MLHF physical functioning scores were initially higher (more impairment) in younger patients but improved in the intervention group. Scores for the older participants (>60 years) were maintained over time for both groups. Walk distance also improved in the younger patients (< 60 years) in the intervention group but showed little change in the older patients (>60 years) in both groups. Intervention patients also showed significantly improved MAACL positive affect scores over time compared to control patients (p =.02).

This behavioral management intervention shows efficacy in physical functioning and may be more effective with younger patients. This intervention should be tested in a multi-center trial.

External Links for this Project

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


Journal Articles

  1. Shively M, Kodiath M, Smith TL, Kelly A, Bone P, Fetterly L, Gardetto N, Shabetai R, Bozzette S, Dracup K. Effect of behavioral management on quality of life in mild heart failure: a randomized controlled trial. Patient education and counseling. 2005 Jul 1; 58(1):27-34. [view]
  2. Shively M, Fox C, Brass-Mynderse NJ. Health-related quality of life as an outcome for patients with heart failure. The Journal of cardiovascular nursing. 1996 Jan 1; 10(2):89-96. [view]
  3. Kodiath M, Kelly A, Shively M. Improving quality of life in patients with heart failure: an innovative behavioral intervention. The Journal of cardiovascular nursing. 2005 Jan 1; 20(1):43-8. [view]
Conference Presentations

  1. Shively M, Kodiath M, Smith TL. Behavioral Management Improves Physical Functioning Outcomes in Veterans with Heart Failure. Paper presented at: VA HSR&D National Meeting; 2003 Feb 1; Washington, DC. [view]

DRA: Health Systems
DRE: Epidemiology, Treatment - Observational
Keywords: Behavior (patient), Chronic disease (other & unspecified), Chronic heart failure, Nursing
MeSH Terms: Quality of Life, Health Behavior, Heart Failure, Congestive, Nursing, Behavior

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.