Abstract Body (Do not enter title and authors here): Introduction: The COOL-HF (caregiver (CG) opportunities for optimizing lifestyles) randomized clinical trial tested a psychoeducational intervention (with and without exercise) to address heart failure (HF) CG risk for poor health outcomes due to the burden of caregiving. These analyses examine factors that affected response to the intervention.
Hypothesis: HF CGs who received the intervention will have improved CG self-efficacy which will mediate improved outcomes (evidenced by lower depressive symptoms and CG burden and better mental health and sleep quality).
Methods: CGs of persons with HF were randomized to 3 groups: usual care, psychoeducational only (PEd) or PEd plus exercise (PEdEx). The psychoeducational intervention included 4-weeks of in-person classes on nutrition, HF education, CG skills, communication, coping, self-care, and health improvement. In addition to sociodemographics, family caregiver version of Self-Care of Heart Failure Index (SCHFI) competency (self-efficacy) scale, Center for Epidemiological Studies-Depression (CES-D) score, Oberst Caregiving Burden Scale (time and difficulty scores), Pittsburgh Sleep Quality Index (PSQI) and Mental Health Continuum (MHC) were measured at baseline and 6m. The indirect mediation effect of the within-participant improvements in CG self-efficacy on outcomes were estimated with structural equation modeling using the lavaan R package to implement the MEMORE (Mediation and Moderation for Repeated Measures) algorithm.
Results: The 127 CGs in the study were aged 55 +/- 11, 92% female, 58% Black, 55% spouses and 70% had a college or higher education. The HF patients’ severity ranged from NYHA class I (25%), II (25%), III (38%), to IV (12%). Significant mediation effects were found in both PEd and PEdEx groups for which SCHFI competence scores increased on average 1.99 +/- 3.15 points (moderate-to-large effect size (es) d=0.63) from baseline to 6m (p<.001), which mediated improvements in depression (indirect effect 95% confidence interval [-3.24, -0.22], small-to-moderate es=-0.18), Oberst time [-3.75, -0.27, es=-0.18], Oberst difficulty [-4.12, -0.64, es=-0.24], PSQI [-1.55, -0.14, es=-0.20] and MHC [0.37, 2.68, es=0.15].
Conclusions: The COOL-HF psychoeducational intervention improved CG competency which mediated improvements in mental health, burden and sleep quality. These data suggest that effort to increase self-efficacy should be a key aspect of HF CG programs to promote improved psychosocial outcomes.