1. Behavior Change and SRD Adetania Pramanik Durga Kudtarkar Shubhshankar M. Sankachelvi

2. Heart Failure Condition in which the heart can’t pump enough blood to meet the body’s needs. The heart can’t fill with enough blood. Heart can’t pump blood to the rest of the body with enough force

3. Prevalence 5 million HF related patients in the US 1.4 million of them were classified as classified as NYHA class III or IV

4. Common Causes Hypertension Condition in which systemic arterial blood pressure is elevated. The heart has to work harder than it should to pump the blood around the body Coronary artery disease is a condition in which plaque builds up inside the coronary arteries which supply oxygen-rich blood to the heart muscles. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.

5. Risk Factors A single risk factor may be enough to cause heart failure, but a combination of factors increases your risk. Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease. Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart. Congenital heart defects. Some people who develop heart failure were born with structural heart defects. Viruses. A viral infection may have damaged your heart muscle. Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure. Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.

6. Recommended Routine The Consensus Recommendations for the Management of Chronic Heart Failure and the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Heart Failure reported three recommendations HF patients routine care: 1. monitor signs of sodium retention 2. comply with medication regimens 3. comply with dietary sodium restrictions

7. How does knowledge aid compliance? Reasons for not maintaining a SRD 1.Lack of Motivation 6% 2.Practical difficulties 6% 3.Not palatable 13% MedicationDietWeight / Exercise Knowledge Adherence

8. How does knowledge aid compliance? Control Group Standard Training Did not take into account social, cultural habits Intervention Group Improved Training More than 50% reduced sodium intake

9. What about readmissions? 1.Only 14% were aware of SRD guidelines. 2.Most HF do not know how to follow an SRD 3.This lack of awareness of potential barrier to effective implementation of SRD 4.Not understand the link between high sodium intake and worsening symptoms 5.Not believe that their adherence to an SRD could relieve worsening symptoms 6.Worsening symptoms = seek treatment

10. What about readmissions? 24-hr Sodium excretion > 3 g = 1.8 times higher risk for cardiac events Group that closely adhered to SRD: Significant drop in frequency and severity of symptoms Longer cardiac-event free survival i.e. lower rates of readmissions due to cardiac problems

11. Difficulty in adhering to SRD.. Why? Misunderstanding of the SRD guidelines Interference with socialization Lack of food selection Little understanding of the sodium content of foods Food-preparation habits Inferior palatability Fast foods and convenience products Detailed dietary information about low sodium foods f and alternative seasonings could improve adherence to an SRD.

12. How do you change habits? Pre ContemplationContemplationPreparationActionMaintenance HF Patients when in the hospital MI, CBT

13. Motivational Interviewing Client – centered, enhance intrinsic motivation to change Empathy (accept -> change) Discrepancy (between current versus goal) Roll with resistance Support self-efficacy Shown to improve cardiovascular health

14. Our Goal Using educational and awareness tools as means for patients to achieve manageable SRD through motivational interviewing while patients are in the hospitals. Going from “My doctor told me..” to intrinsic change Reducing readmissions by increasing adherence to SRD by reducing symptoms

15. Solution Concept 1 1.Avoid using salt shaker when consuming your meal 2.Avoid using salt when preparing food 3.Read nutrition labels 4.Avoid canned vegetables, frozen prepared foods 5.Avoid/understand fast food products (e.g., taco bell average sodium >1000 per item)

16. Solution Concept 2

17. Solution Concept 2 Gaming for behavior change Behavior change is difficult. Many technological solutions available in the market. Engineering-driven features and functions, or a creative campaign cannot by themselves ensure product success because they cannot predict consumer behavior

18. Gaming is Addictive! An estimated 3 billion hours are currently spent on gaming every week. By age 21, the average American will have spent more than 10,000 hours playing video games — the equivalent to 5 years of work at a full time job! The total amount of time that World of Warcraft has been played is 5.93 million years. what is it about games that enables this extraordinary degree of engagement and can it be used to motivate healthy behaviour change?

19. Design Attributes For Creating Behavioral Change:- In order to maximize consumer engagement utilizing gaming elements to change behavior relies on 4 critical design attributes: entertaining, competitive, visual, and rewarding. 1.Entertaining :- American Heart Association and Nintendo recently announced a first-of-its-kind strategic partnership designed to help people create healthy lifestyles through physically active play. 2. Competitive :- Nike+ is a small device that records the distance and pace of a walk or run. Nike+ also allows runners to meet and challenge other runners, ask questions, and give feedback. The corresponding Nike+ website includes a user-generated challenge gallery, a route naming tool, iPod compatibility, a distance-traveled club, and fastest 5K club

20. 3.Visual :-When Toyota began visualizing fuel consumption for drivers in their Prius models, they created a “fuel economy game,” allowing the driver to minimize gas usage with real time information. The phenomenon is known as the Prius Effect. 4. Rewarding :- Rewards that create social value tied to a meaningful cause are more effective over the long term and have a greater likelihood of encouraging others to do the same.

21. References Son, Y., Lee, Y., & Song, E. (2011). Adherence to a Sodium-restricted Diet is Associated with Lower Symptom Burden and Longer Cardiac Event-free Survival in Patients with Heart Failure. Journal of Clinical Nursing, 20(21/22), 3029-3038. Philipson, H., Ekman, I., Swedberg, K., & Schaufelberger, M. (2010). A Pilot Study of Salt and Water Restriction in Patients with Chronic Heart Failure.Scandinavian Cardiovascular Journal,44(4), 209-214. Wal, M., Jaarsma, T., Moser, D., Veeger, N., van Gilst, W., et al. (2006). Compliance in Heart Failure Patients: The Importance of Knowledge and Beliefs.European Heart Journal, 27(4), 434-440. Zimmerman, G., Olsen, C., & Bosworth, M. (2000). A 'Stages of Change' Approach to Helping Patients Change Behavior. American Family Physician,61(5), 1409-1416. Thompson, D., Chair, S., Chan, S., Astin, F., Davidson, P., et al. (2011). Motivational Interviewing: A Useful Approach to Improving Cardiovascular Health?. Journal of Clinical Nursing,20(9/10), 1236-1244. Kathleen M. McCauley and Mary D. Naylor - Managing Heart Failure: Economic Impact and Outcomes -- Improving Outcomes in Heart Failure: An Interdisciplinary Approach Marjorie Funk, Kerry A. Milner, and Harlan M. Krumholz - Epidemiology of Heart Failure - Improving Outcomes in Heart Failure: An Interdisciplinary Approach Nutritional Management of the Patient with Heart Failure - Susan J. Bennett, Laurie Hackward, and Sara A. Blackburn