Motivational interviewing as a new approach to improve outcome through self-care behavioural changes in advanced heart failure patient: a case report

Abstract

Background: A lack of adherence and inadequate self-care behaviours are common reasons for recurrent hospitalizations among patients with heart failure (HF). Although patients recognize the importance of HF self-care, it is sometimes difficult to correct their behavioural patterns. Motivational interviewing is a communication technique to resolve ambivalence towards changing behaviour, and it has been widely used to promote behavioural changes and improve outcomes in various chronic diseases. We described a case of advanced HF with reduced ejection fraction in which motivational interviewing lead to stabilize the patient's condition.

Case summary: A 33-year-old man was diagnosed with dilated cardiomyopathy who experienced repeated episodes of HF requiring hospitalization despite optimal guideline-based HF treatment. Transthoracic echocardiography disclosed a severely reduced left ventricular (LV) contraction (LV ejection fraction 18%) and cardiopulmonary exercise testing disclosed markedly reduced functional capacity and increased ventilatory response (peak VO2 of 10.7 mL/min/kg, predicted peak VO2 of 34.7% and VE/VCO2 slope of 35.2). In this case, poor adherence to self-care such as excessive fluid intake and excessive daily activities after hospital discharge was the main cause of recurrent hospitalization for HF. Despite repeated patient education to correct his diet and lifestyle, he could not change his lifestyle behaviour. However, motivational interviewing dramatically helped stabilize the patient's condition and prevent HF re-hospitalization.

Discussion: In general, patients with advanced HF and reduced ejection fraction despite optimal medical therapy should be evaluated to assess their eligibility of cardiac transplantation or palliative care. Motivational interviewing might represent a new therapeutic approach for stabilizing and preventing HF through self-care behavioural changes, even in patients with advanced HF and severely reduced ejection fraction.

Keywords: Advanced heart failure; Case report; Heart failure with reduced ejection fraction (HFrEF); Motivational interviewing; Patient education; Self-care.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Figure 1

B-type natriuretic peptide trend from first admission for heart failure. Significant improvement in B-type natriuretic peptide was achieved after motivational interviewing. BNP, B-type natriuretic peptide; CRT, cardiac resynchronization therapy; MI, motivational interviewing; USCE, usual self-care education.

Figure 2

Chronological changes on the radiograph (A and D) and echocardiography of parasternal long-axis views in diastole (B and E) and systole (C and F) before (December 2019) and 10 months after (October 2020) motivational interviewing. Significant improvements in terms of cardiomegaly, left ventricular function, and mitral regurgitation after 10 months of motivational interviewing.

Figure 3

Motivational interviewing as a counselling style based on the following assumption.

Figure 4

Patient’s message.