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.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT00415545.

背景：注意体重增加和呼吸困难是心力衰竭（HF）患者教育的中心原则。但是，尚不清楚日记的使用是否可以改善患者的预后。这项研究的目的是比较完成和未完成每日体重和症状自我评估日记的农村HF患者的死亡率，并确定日记使用的预测因素。

方法和结果：这是一项针对三组随机对照试验的二次分析，该试验针对HF自我护理教育，分为2个干预组与对照组，分别给予了24个月的日记以追踪每日体重，HF症状以及对症状变化的反应。平均年龄为66±13，男性为58％，完整日记为67％（n = 393）。我们从开始使用日记的前三个月起分为5组（不使用，低，中，高和非常高），然后分析事件发生的时间（心脏死亡率，全因死亡率和HF相关的再入院） 3个月。与不使用日记的患者相比，大量和非常多的日记使用者不太可能出现全因死亡率（P = 0.02和P分别为0.01）。在调整后的模型中，自我报告的久坐生活方式与较少使用日记相关（优势比为0.66； 95％置信区间为0.46-0.95；P = 0.03）。在调整后的模型中，抑郁和性别不是日记使用的重要预测指标。

结论：在这项针对393名农村HF患者的研究中，我们发现更多地使用日记与更长的生存期相关。这些发现表明，更多地参与自我保健行为与更好的心衰结果相关。

临床试验注册： URL：https : //www.clinicaltrials.gov。唯一标识符：NCT00415545。