Efeito de uma estratégia de transição do cuidado baseada em videomonitoramento, teach-back e entrevista motivacional no autocuidado de pacientes com insuficiência cardíaca: ensaio clínico randomizado

Abstract

Introduction: Heart failure (HF) is a complex clinical syndrome associated with high rates of hospitalization, mortality, and readmissions, often related to poor therapeutic adherence, fragmentation of care, and weaknesses during the transition between levels of the healthcare system. Structured care transition strategies, combined with the use of technologies such as video monitoring and behavior change methodologies, have been proposed as alternatives to strengthen self-care and reduce adverse outcomes. Objective: To evaluate the effectiveness of a structured hospital-to-primary care transition strategy, combined with remote clinical followup via video monitoring, grounded in motivational interviewing (MI) and teach-back (TB), on self-care in patients with HF, compared to usual care, over a 180-day follow-up period. Materials and Methods: This was a single-center randomized clinical trial with blinded outcome assessment, conducted with patients with decompensated HF and reduced ejection fraction (LVEF <40%), treated at the Hospital de Clínicas of the Federal University of Uberlândia. Participants were randomized into an intervention group (IG) and a control group (CG). At hospital discharge, the IG received an educational booklet, sharing of the discharge summary with primary care, and nursing consultations via video monitoring through WhatsApp® at 7, 30, 60, and 180 days post-discharge, using MI and TB, while the CG received usual care. The primary outcome was self-care, assessed using the European Self-Care Scale. Longitudinal analysis was performed using Generalized Estimating Equations (GEE), with models adjusted for age, sex, ejection fraction, and NYHA functional class, and analyses were conducted using R software. Results: A total of 140 patients were included (CG = 73; IG = 67), with a mean age of 65.59 ± 13.72 years in the CG and 63.94 ± 14.28 years in the IG, predominantly NYHA functional class II (n = 60; 42.9%), and a mean LVEF of 30.49 ± 6.49%. The GEE model adjusted for age, sex, LVEF, and NYHA functional class showed a significant interaction between group and time (χ² = 27.22; p < 0.001). Adjusted mean total self-care scores remained stable in the CG over time, whereas a progressive reduction in scores was observed in the IG (29.07 ± 0.92 at baseline, 24.38 ± 1.08 at 30 days, 19.84 ± 0.75 at 60 days, and 19.92 ± 0.90 at 180 days). Adjusted between-group differences (IG − CG) were −0.78 at baseline, −6.28 at 30 days, −9.32 at 60 days, and −10.09 points at 180 days, indicating a clinically and statistically significant improvement in self-care in the IG. Lower rates of readmission (32.14% vs. 11.76%) and mortality (5.36% vs. 1.96%) were also observed in the IG. Conclusions: The nurse-led care transition intervention, combining MI, TB, and clinical video monitoring, significantly improved self-care in patients with HF over 180 days, in addition to reducing readmissions and mortality, supporting the incorporation of these strategies into care transition models to enhance patient engagement and sustain self-care